Mandibular advancer and method of installing the same

ABSTRACT

Multiple embodiments of mandibular advancers are disclosed. Advancement of the mandible is affected by mounting such an mandibular advancer on each side of both the upper dental arch and the lower dental arch. One embodiment of such an mandibular advancer includes a casting form with a rigid polymerized material therein and which includes a casting form mandibular advancement incline formed on an end thereof. The casting form mandibular advancement incline may wear away in certain instances to expose the polymerized material therebeneath which has been cured and assumed the shape of this casting form mandibular advancement incline. Other embodiments of such mandibular advancers include a crown or a band, each of which has a mandibular advancement inclineas a part there of (e.g., integrally, via separate attachment). Certain of these crowns or the band with a mandibular advancement incline associated therewith may be disposed within the above-noted casting form and encapsulated within the noted polymerized material. Preferably this disposes the mandibular advancement incline associated with the crown/band in interfacing relation with the casting form mandibular advancement incline.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application is a continuation-in-part of U.S. patentapplication Ser. No. 09/559,792, which is entitled “MANDIBULAR ADVANCERAND METHOD OF INSTALLING THE SAME,” and which was filed on Apr. 27, 2000(abandoned), which is a continuation-in-part of U.S. patent applicationSer. No. 09/533,892, which is entitled “MANDIBULAR ADVANCER AND METHODFOR ASSEMBLING THE SAME,” and which was filed on Mar. 22, 2000(abandoned).

FIELD OF THE INVENTION

The present invention generally relates to the field of the advancementof the mandible or lower jaw in typically an orthodontic treatmentsetting (e.g., to treat an orthodontic patient with a Class IImalocclusion, to treat an orthodontic patient with a Class IIImalocclusion) and, more particularly, to various mandibular advancementdevices which include a mandibular advancement incline for affectingmandibular advancement and which may be fixedly attached to one or moreteeth of the patient.

BACKGROUND OF THE INVENTION

Class II malocclusions exist when an individual's upperjaw or maxillaprotrudes further out from the individual's face than his/her lowerjawor mandible. Conversely, Class III malocclusions exist when anindividual's lower jaw or mandible protrudes further out from theindividual's face than his/her upper jaw or maxilla. Treatment of aClass II malocclusion may entail exerting a functional orthopedic forceon the individual's lowerjaw or mandible so as to advance the same in amesial or “outward” direction.

One way in which orthodontic treatment forces have been applied toaddress a Class II malocclusion is through a facebow to retract theupper jaw or maxilla to match the position of a retruded mandible. As70% of Class II malocclusions are due to a deficient mandible, it ismore beneficial to the patient to advance the mandible than to retractthe maxilla. This results in a better profile, and a more balancedfacial appearance, compared to orthodontic techniques which retract themaxillary teeth to match the position of a retrusive mandible. Thedisadvantage of this approach is that the nose continues to grow, whenthe maxilla is retracted, and the nose becomes unduly prominent in theprofile, while the maxilla and mandible are retracted to a retrusiveposition. This approach may align the anterior teeth, but at the sametime, is detrimental to the patient's facial appearance. The alternativeto a functional orthopedic approach to correct a mandibular retrusionwould entail a combination of orthodontic and surgical correction toalign the teeth and advance the mandible to match the correctlypositioned maxilla. Orthopedic correction achieves a similar result bycorrecting the mandibular position without surgery in many cases. It isimportant to integrate orthopedic techniques with conventionalorthodontic techniques, to allow the simultaneous correction of skeletaland dental abnormalities.

Another option which has been utilized to affect mesially-directedmandibular advancement is through what has been characterized in theorthodontic industry as “bite blocks.” Bite blocks generally include aplanar surface which is disposed at an angle relative to an individual'socclusal plane when the bite blocks are installed on the patient.Typically a pair of bite blocks are installed on the occlusal surface ofthe patient's upper dental arch on opposite sides thereof (i.e., one onthe right side of the upper dental arch, and another on the left side ofthe upper dental arch), while a pair of bite blocks are also installedon the occlusal surface of the patient's lower dental arch on oppositesides thereof (i.e., one on the right side of the lower dental arch, andanother on the left side of the lower dental arch). Each of these biteblocks are installed so that there is a camming-like action between thetwo bite blocks which are occlusally installed on the patient's upperarch and their corresponding bite blocks which are occlusally installedon the patient's lower arch.

Both fixed and removable attachment techniques have been suggested forbite blocks generally of the above-noted type. “Fixed” in theorthodontic treatment sense and also as used herein means that aparticular appliance is installed on the orthodontic patient in such amanner so that at least in theory the orthodontic patient will not beable to readily remove the appliance, but so that the appliance may beremoved by the orthodontic practitioner utilizing the proper tool(s).“Removable” in the orthodontic treatment sense and also as used hereinmeans that a particular appliance is installed on the orthodonticpatient in such a manner so that the appliance may be readily removed byboth the orthodontic patient and practitioner.

Since the beginning of the twentieth century, orthopedic appliances havetraditionally been removable by the patient, therefore being dependenton patient cooperation to achieve the beneficial effects of treatment.The improvements of the present invention addressed below adapt theprinciples of orthopedic correction, already proven in removableappliance techniques, to fixed orthopedic appliances, thus allowingbetter control, and better results to be achieved by the unrestrictedfull time wear of orthopedic appliances.

BRIEF SUMMARY OF THE INVENTION

The present invention generally relates to the advancement of themandible in typically an orthodontic treatment setting and, moreparticularly, to the manner in which one or more components used toaffect mandibular advancement are assembled for installation on apatient. Both mesial advancement (i.e., treatment of Class IImalocclusions) and distal advancement or retraction (i.e., treatment ofClass III malocclusions) of the mandible may be affected utilizingprinciples of the present invention. Nomenclature which will be usedherein to describe the various aspects of the present invention definesthe corresponding structure/step in relation to the “installed” positionor to the position which is assumed within the patient's mouth, andfurther conforms to the way in which such terms are commonly used in thedental or orthodontic practice to describe particular surfaces of theteeth and orthodontic appliances used in combination therewith and/ororientations relating thereto.

A first aspect of the present invention is a mandibular advancementsystem which includes a casting form. Multiple options are provided inrelation to the particular manner in which a mandibular advancementincline surface is mounted within a patient's mouth through use of thisparticular casting form. The casting form of this first aspect includesa casting form occlusal surface (e.g., on the “occlusal” side of thecasting form when in the patient's mouth), a casting form buccal surface(e.g., on the “buccal” side of the casting form when in the patient'smouth), a casting form lingual surface (e.g., on the “lingual” side ofthe casting for m when in the patient's mouth), and a casting formmandibular advancement incline for at least facilitating mandibularadvancement. Typically the casting form mandibular advancement inclinewill be disposed on either the mesial or distal end of the casting form.One of these casting forms may be installed on one or both sides of thepatient's upper dental arch, on one or both sides of an patient's lowerdental arch, or on one or both sides of both of the patient's upper andlower dental arches. These various options will be discussed in moredetail below, as well as the various ways in which the installation maybe affected.

The casting form occlusal, buccal, and lingual surfaces, as well as themandibular advancement incline, collectively define a hollow repositoryof sorts (e.g., a hollow, three-dimensional generally wedge-shapedstructure). Disposed within this repository of the casting form is amaterial which has been polymerized to provide a desired degree ofrigidity thereto. Typically this material will be provided to thecasting form in somewhat of a “fluid” or “flowable” state (e.g., apaste), such that one could think of the casting form as a “bathtub” ortrough of sorts for retaining this fluid-like or flowable materialtherein for subsequent polymerization. In any case, the casting form isinstalled on the desired side of the desired dental arch of the patientsuch that this now polymerized material at least projects toward atleast the occlusal surface of at least two or more teeth in thecorresponding dental arch (e.g., the polymerized material may extendalong the buccal and/or lingual sides of the noted teeth as well). Anappropriate chemically polymerizing orthodontic bonding system (e.g., aprimer and paste, a paste-paste, a photo-initiated orthodontic bondingsystem) may be applied to those surfaces of the polymerized materialwhich will interface with the corresponding dental arch, or the curingof the flowable material on the patient's teeth may itself establish thebond between the polymerizable material and the teeth (e.g., usingtraditional/customary orthodontic composite resins for the flowablematerial and to define the polymerized material when cured).

The casting form's mandibular advancement incline is positioned on thecasting form relative to this polymerized material so that when thecasting form is installed in the above-noted manner, the casting formmandibular advancement incline is disposed at an angle relative to theocclusal plane of the corresponding dental arch, and further preferablyextends at least substantially perpendicularly across the major axis ofthe dental arch. Engagement of this casting form mandibular advancementincline (or the preferably conformingly-shaped underlying structure ifthe casting form material which forms the casting form mandibularadvancement incline has worn away) by appropriate structure on theopposing dental arch (e.g., another mandibular advancer installed on thesame side of the opposing dental arch and with a generally oppositelyoriented mandibular advancement incline) may be used to at leastfacilitate advancement of the mandible in the mesial or the distaldirection by the noted camming-like action.

Various refinements exist of the features noted in relation to thesubject first aspect of the present invention. Further features may alsobe incorporated in the subject first aspect of the present invention aswell. These refinements and additional features may exist individuallyor in any combination. The casting form occlusal surface may becontoured for various purposes. That portion of the casting formocclusal surface which extends distally or mesially of the mandibularadvancement incline (as the case may be depending upon, for instance,the type of malocclusion being treated and/or whether the casting formis for the upper or lower arch), may be a substantially planar surfaceand further may be disposed at least substantially parallel with theocclusal plane of the dental arch on which the casting form isinstalled. Preferably the mesio-distal extent of this particular surfaceis at least as great as the mesio-distal extent of the tooth within thedental arch which underlies this surface. Configuring at least thisportion of the casting form occlusal surface in this manner provides asurface on which a mandibular advancer on the opposing dental arch mayengage the casting form occlusal surface of the casting form associatedwith this first aspect to slide thereon, through a mesially or distallydirected movement of the mandible by the patient, so as to position theopposing mandibular advancement incline for engagement with the castingform mandibular advancement incline associated with this first aspect orunderlying structure as noted above.

All of the casting form occlusal surface need not have the same profile.For instance, in the case where that portion of the casting formocclusal surface which extends from the casting form mandibularadvancement incline is disposed at least generally parallel with theocclusal plane of the dental arch on which the casting form is installed(e.g., a first section of the casting form occlusal surface), theremainder of the casting form occlusal surface (e.g., a second section),may extend away from this first section not in parallel relation withthe corresponding occlusal plane, but instead at least generally towardthe patient's gingiva which is associated with the dental arch on whichthe casting form is installed. Stated another way, the second section ofthe casting form occlusal surface may slant toward the dental arch onwhich the casting form is installed.

All or at least a portion of the casting form occlusal surface may becontoured to account for orthodontic conditions other than a Class II orIII malocclusion. For instance, all or part of the casting form occlusalsurface may be recessed a certain degree to account for what is known asa “deep bite” orthodontic condition (e.g., to present a concavesurface). In addition, all or part of the casting form occlusal surfacemay be bulged a certain degree or the casting form may have an enhancedocclusal-gingival extent to account for what is known as an “open bite”orthodontic condition.

The distance between the casting form buccal and lingual surfaces, orthe “width” of the casting form, may be selected to be at least slightlygreater than the distance between the buccal and lingual surfaces of thedental arch on which the casting form is to be installed. In this casethe casting form will extend along a portion of the buccal and/orlingual surfaces of the subject dental arch when installed thereon, aswell as along a portion of the subject dental arch's occlusal surface.Polymerized material may thereby extend along these buccal and/orlingual surfaces of the subject dental arch as well to provide a morerobust interconnection of the mandibular advancement system with thesubject dental arch.

The occlusal-gingival extent of the casting form buccal and lingualsurfaces need not be equal in relation to the first aspect of thepresent invention. Materials may be used to make the casting form whichwill allow the orthodontic practitioner, or more typically personnelassociated with an orthodontic laboratory, to trim the casting form tothe desired degree prior to the disposal of the polymerizable materialtherein. For instance, the occlusal-gingival extent of the casting formlingual surface may be greater than the occlusal-gingival extent of thecasting form buccal surface, or vice versa. One advantage of having theenhanced occlusal-gingival extent on the casting form lingual surface isthat the casting form and polymerized material may encapsulate certainorthodontic armamentarium disposed on the lingual surface of the subjectdental arch (e.g., lingual arches) to provide a more robustinterconnection of the casting form with the corresponding dental arch.In other cases it may be desirable for the casting form lingual and/orbuccal surface to have a reduced occlusal-gingival extent over certainportions thereof so as to not interfere with orthodontic armamentariumdisposed on the lingual and/or buccal surface of the subject dentalarch. Relatedly, the occlusal-gingival extent of the casting form buccaland/or lingual surfaces need not be the same throughout the entiremesio-distal extent or “length” of the casting form. For instance, thatmesio-distal section of the casting form buccal and/or lingual surfaceswhich is disposed adjacent to and/or extends mesio-distally from thecasting form mandibular advancement incline may have an enhancedocclusal-gingival extent compared to another mesio-distal section of thecasting form buccal and/or lingual surfaces which is disposed furtherfrom that end of the casting form which includes the casting formmandibular advancement incline. This may be desirable for purposes ofsecure retention by engaging the buccal or lingual surfaces of theunderlying teeth.

The casting form of the subject first aspect may include structure whichextends from a gingival-most edge of the casting form mandibularadvancement incline, and in the direction of the dental arch on whichthe casting form is installed. In one embodiment this “extension” may becharacterized as having an at least generally u-shaped profile so as toat least generally approximate that portion of the dental arch overwhich the extension is disposed. Typically the casting form will bepositioned on the subject dental arch so that this extension is disposedinterproximally between two adjacent teeth within the subject dentalarch. The occlusal-gingival extent of this extension may be greater thanthe occlusal-gingival extent of the casting form buccal and/or lingualsurfaces for purposes of contouring the appliance to engage thesupporting teeth, or as a means of attachment to a lingual arch whichmay be disposed to control the transverse dimension simultaneously withthe mandibular advancement. In other cases the noted extension may havethe same occlusal-gingival extent as adjacent portions of the castingform lingual and/or buccal surfaces.

As noted above, the material from which the casting form of the subjectfirst aspect of the present invention is made is preferably that whichwill allow an orthodontic practitioner or orthodontic laboratorytechnician to readily trim the casting form to the desired shape for agiven patient. Moreover, preferably the material from which the castingform is made will further crosslink with the polymerizable materialdisposed therein to further enhance the interconnection between thecasting form and this polymerizable material.

Significant flexibility is provided by the casting form associated withthe subject first aspect in relation to how the mandibular advancementsystem is actually installed on the patient. In one embodiment, thecasting form with the polymerized material therein may provide theentirety of one mandibular advancer of the mandibular advancement systemof the first aspect. A suitable orthodontic bonding system may beapplied in this case to those portions of the polymerized materialwithin the casting form which will project toward the subject dentalarch (when the casting form/polymerized material is initially formed ona stone casting and as will be discussed in more detail below), or thepolymerizable material may be allowed to cure while on the teeth, allsuch that the casting form and polymerized material may be fixedlybonded directly to the subject dental arch. Another option is to use thecasting form associated with the subject first aspect in combinationwith a crown as a mandibular advancer of the mandibular advancementsystem of the first aspect.

Generally, this crown may be disposed within the “hollow” of the castingform and be securely retained therein by the polymerized material. Inthis case not only would portions of the polymerized material within thecasting form be directly fixedly bonded to the subject dental arch, butthe crown would also be disposed over a tooth within this particulardental arch and be fixedly bonded thereto.

One embodiment of a combination casting form/crown mandibular advancerutilizes a crown assembly. This crown assembly may be disposed withinthe casting form of the subject first aspect and includes a crown with acrown occlusal surface which “overlies” a single tooth of the dentalarch on which the mandibular advancement system of the first aspect isinstalled, as well as an annular crown skirt which is disposed aboutthis particular tooth. A crown mandibular advancement incline frame isseparately attached to this particular crown. Stated another way, thecrown mandibular advancement incline frame and crown in this case areseparate parts, and are thereby not formed from a single piece ofmaterial (i.e., there is at least one joint therebetween). Thisparticular crown mandibular advancement incline frame includes first andsecond frame sections which are configured such that there is an acuteangle therebetween. The first frame section is disposed on and isappropriately attached to the crown occlusal surface of the crown (e.g.,via one or more spot welds, via brazing) so that the second framesection extends away from both the first frame section and the crownocclusal surface of the crown. The second frame section may therefore becharacterized as a crown mandibular advancement incline, and such may bea flat, planar surface. In one embodiment, the first frame sectionextends beyond the crown occlusal surface such that the second framesection is disposed at an interproximal location between two teethwithin the dental arch on which the mandibular advancement system of thefirst aspect is installed. In any case, the first frame section ismounted on the crown occlusal surface of the crown such that the secondframe section is disposed at least generally proximate to and at leastgenerally parallel with the casting form mandibular advancement incline.Preferably the second frame section and casting form mandibularadvancement incline are disposed in interfacing relation. In this case,polymerized material will typically occupy the entirety of the spacebetween the crown occlusal surface of the crown and the casting formocclusal surface.

Attachment of the first frame section to the crown occlusal surface ofthe crown may be facilitated by having the crown occlusal surface be atleast substantially planar. Conventional crowns include an occlusalsurface which is contoured to at least generally replicate the occlusalsurface of a tooth, and thereby the crown which is associated with themandibular advancement system of the first aspect of the presentinvention in this instance is a significant departure from theseconventional crowns. Enhancement of the interconnection between thecrown and the crown mandibular advancement incline frame may be realizedby incorporating at least one, and more preferably a plurality of,apertures which each extend through the entire occlusal-gingival extentof the first frame section. At least one of these apertures may bedisposed so as to expose a portion of the crown occlusal surface onwhich the first frame section overlies. Polymerized material may occupythe entire extent of any such apertures. At least one aperture may alsobe disposed on that portion of the first frame section which extendsbeyond the crown occlusal surface of the crown. This may facilitate thedirecting of polymerizable material within the space defined between thefirst and second frame sections. Polymerizable material may be capturedwithin this space between the first and second frame sections by havinga pair of extensions which project from the opposite sides of the firstframe section at least toward the “free” end of the second frame sectionor at least an apex thereof (e.g., a pair of triangularly-shaped“ears”).

Another crown which may be used in combination with the casting form todefine a mandibular advancer of the mandibular advancement system of thesubject first aspect includes an integral crown mandibular advancementincline which may be a flat, planar surface or alternatively which mayhave a curvature about a reference axis which is at least generallyparallel with a tooth-long axis of a tooth on which the crown isinstalled (e.g., defined by rotating a line about such an axis). Thatis, the crown occlusal surface, annular crown skirt, and crownmandibular advancement incline are formed from a single piece ofmaterial in this case and thereby with no joint of any kindtherebetween. This crown mandibular advancement incline is disposed onthe crown so as to be disposed at least generally proximate to and atleast generally parallel with the casting form mandibular advancementincline when the casting form and crown are installed on one side of thedesired dental arch. Preferably, the crown mandibular advancementincline and casting form mandibular advancement incline are disposed ininterfacing relation.

In one embodiment, the above-noted crown mandibular advancement inclineis disposed on a mesial or distal end of the crown. This could be viewedas being at a location where the crown occlusal surface and skirt wouldotherwise intersect. In another embodiment, the crown mandibularadvancement incline is formed into a “mid” or “interior” portion of thecrown occlusal surface. Stated another way, the crown mandibularadvancement incline may be disposed somewhere between the mesial anddistal extremes of the crown. For instance, the crown occlusal surfacemay include first and second sections which are disposed at differentelevations (i.e., one being “raised” relative to the other) and thecrown mandibular advancement incline may be disposed therebetween. Inyet another embodiment, the crown mandibular advancement incline maydefine at least substantially the entirety of the crown occlusal surfaceof the crown. In this case, the crown mandibular advancement incline maybe oriented so as to be disposed at an angle of no more than about 20°relative to a plane which is parallel with the occlusal plane of thedental arch on which this particular crown is installed.

Regardless of the positioning of the crown mandibular advancementincline on the above-noted integrally formed crown, the crown may havean increased occlusal-gingival extent in relation to conventionalcrowns. In this regard and in one embodiment, there is at least about a1.5 mm minimum space between the apex of the crown occlusal surface andthe occlusal-most surface of the tooth over which the crown is disposedto allow for the incorporation of the crown mandibular advancementincline integrally with the crown. This space may remain hollow or maybe filled with polymerizable material to enhance the rigidity of thecrown mandibular advancement incline.

Another variation of a crown which may be used in combination with thecasting form to define a mandibular advancer of the mandibularadvancement system of the subject first aspect includes an extensionwhich projects away from the annular crown skirt. The crown mandibularadvancement incline in this case is thereby disposed beyond the “oval”of the crown on the “free” end of this extension (e.g., at the end ofthis cantilever). Stated another way, the crown mandibular advancementincline in this case is disposed on an end of the extension which isopposite that which interfaces with the crown skirt. Extensions whichare integrally formed with the crown (i.e., formed from the same pieceof material and with no joint of any kind therebetween, such as by ahydroforming process), as well as an extension which is separatelyformed from the crown and thereafter separately attached thereto, arecontemplated. This particular embodiment may be effective at the moreadvanced stages of the treatment of a Class II or III malocclusion bymoving the activating surface (e.g., the crown mandibular advancementincline) more mesially or distally to account for that amount of mesialor distal movement of the mandible which has already been achieved, asthe case may be. In any case, the crown mandibular advancement inclineis preferably a flat, planar surface.

Conventional orthodontic bands may also be used in combination with theabove-described casting form to define a mandibular advancer of themandibular advancement system of the subject first aspect. Generally,this band may be disposed within the “hollow” of the casting form and besecurely retained therein by the polymerized material. In this case notonly would portions of the polymerized material within the casting formbe directly bonded to the subject dental arch, but the orthodontic bandwould also be disposed about a tooth within this particular dental archand then bonded thereto. A band mandibular advancement incline frame isassociated with this band. One embodiment entails attaching this bandmandibular advancement incline frame to both the occlusal and buccalsurfaces of the band. In any case, the band mandibular advancementincline frame is oriented on the band so that its band mandibularadvancement incline, which is disposed on the free end thereof, isdisposed at least generally proximate to and a least generally parallelwith the casting form mandibular advancement incline when the castingform and band are installed on one side of the desired dental arch.Preferably, the band mandibular advancement incline and casting formmandibular advancement incline are disposed in interfacing relation. Inone embodiment, the band mandibular advancement incline frame isencapsulated within the polymerized material, which again is retainedwithin and preferably cross-linked with the casting form. Moreover,preferably the band mandibular advancement incline is a flat, planarsurface.

A second aspect of the present invention is directed to a method forassembling a mandibular advancement system (e.g., of the type describedwith regard to the first aspect) for use by a patient. The methodincludes the steps of disposing a polymerizable material within acasting form which includes a casting form mandibular advancementincline disposed on typically a mesial or distal end thereof. Thecasting form with the polymerizable material therein is thereafterdisposed in overlying relation to least part of at least two tooth-likestructures which are associated with a certain dental arch of a patient.The term “at least two tooth-like structures” means that this step maybe affected on a stone casting which has been previously made of thesubject dental arch, and which are thereby not the patient's actualteeth, as well as directly on the patient's teeth. The casting form ismore particularly positioned on at least the occlusal surface of thenoted “structures” and the polymerizable material is cured into an atleast substantially rigid form so that the casting form mandibularadvancement incline is disposed in a proper position. This “properposition” is one where the casting form mandibular advancement inclineis disposed at an angle relative to an occlusal plane of the dental archon which the casting form with polymerized material therein isultimately installed within the patient's mouth. Disposing the castingform mandibular advancement incline at this angle facilitates theprovision of an “activating” surface for affecting mandibularadvancement.

Various refinements exist of the features noted in relation to thesubject second aspect of the present invention. Further features mayalso be incorporated in the subject second aspect of the presentinvention as well. These refinements and additional features may existindividually or in any combination. One way to assemble the mandibularadvancement system associated with the second aspect is in anorthodontic laboratory environment or the like. In this case, a stonecasting is made of the dental arch on which the mandibular advancementsystem which is associated with the second aspect is to be installed. Anappropriate release agent is typically applied to relevant portions ofthis stone casting. Thereafter, the casting form with the polymerizablematerial therein is positioned on the stone casting at the desiredlocale. The polymerizable material interfaces with at least the occlusalsurface of the dental arch which is replicated by the stone casting, andpossibly its buccal and/or lingual surfaces as well (e.g., the castingform may extend along at least a portion of the buccal and/or lingualsurfaces of the subject dental arch, as well as along part of itsocclusal surface). After the polymerizable material has had a chance toat least partially cure while on the stone casting (e.g., so as toretain the shape of the polymerizable material when removed from thestone casting), the casting form with the at least partially curedpolymerizable material therein is removed from the stone casting.Typically the casting form with the at least partially curedpolymerizable material will then be disposed within an appropriate ovenor the like to complete the curing of the polymerizable material to thedesired degree of rigidity. Installation of this casting form and thenow polymerized material on the corresponding side of the correspondingdental arch of the patient is then affected “chairside” by theorthodontic practitioner applying an appropriate orthodontic bondingsystem to least part of the rigid polymerized material within thecasting form, and thereafter positioning the casting form withpolymerized material therein over at least two teeth within thecorresponding dental arch of the patient.

The mandibular advancement system associated with the second aspect mayalso be assembled directly on the teeth of the patient. That is, thecasting form with the polymerizable material therein may be disposedover at least two teeth on one side of a particular dental arch of thepatient so as to position the casting form mandibular advancementincline in the above-noted position. The polymerizable material may thenbe totally cured to a desired degree of rigidity within the mouth of thepatient. This may entail directing an appropriate light source at thecasting form to cure the polymerizable material therewithin. Enhancementof this type of curing operation is realized by forming the casting formfrom a material with at least a certain degree of transparency.

As noted, the various features discussed above in relation to the firstaspect of the present invention may be incorporated in this secondaspect as well. For instance, the casting form with thepolymerizable/polymerized material therein may be installed by itself onone side of one of the patient's dental arches for providing amandibular advancement incline for affecting mandibular advancement. Anyof the crowns or the band discussed above in relation to the firstaspect of the present invention may also be disposed within the castingform and thereby integrated therewith for providing a mandibularadvancer in association with this second aspect and which is attached tothe corresponding side of the corresponding dental arch of the patient.

A third aspect of the present invention relates to a crown for affectingmandibular advancement. This particular crown includes a crown occlusalsurface which is disposable over an occlusal surface of a tooth within agiven dental arch. An annular crown skirt extends away from this crownocclusal surface, toward the patient's gingiva when installed on atooth, and about this tooth at this time as well. The crown of thisthird aspect further includes a crown mandibular advancement incline foraffecting mandibular movement. In this regard, the crown mandibularadvancement incline may be a substantially planar surface or may bedefined by a line which is rotated about a reference axis which isdisposed at least generally parallel with a tooth-long axis of the toothon which the corresponding crown is installed (e.g., having a curvaturedisposed about such an axis), is disposed at an angle relative to theocclusal plane associated with the corresponding dental arch when thecrown in installed, and further extends at least substantiallyperpendicularly across the major axis of the corresponding dental archwhen the crown is installed (e.g., the crown mandibular advancementincline extends at least generally from a lingual surface of the crownto a buccal surface of the crown).

Various refinements exist of the features noted in relation to thesubject third aspect of the present invention. Further features may alsobe incorporated in the subject third aspect of the present invention aswell. These refinements and additional features may exist individuallyor in any combination. The crown mandibular advancement incline may beincorporated in the crown occlusal surface. For instance, the crownocclusal surface may include first and second sections which aredisposed at different elevations on the crown occlusal surface, and thecrown mandibular advancement incline may extend between these first andsecond sections (e.g., at a more “interior” portion of the crownocclusal surface). Another way of characterizing this configuration isthat the crown occlusal surface includes a discrete raised section, withthe crown mandibular advancement incline being that surface whichdefines a sidewall which interconnects this raised section with aremainder of the crown occlusal surface.

The crown mandibular advancement incline of the subject third aspect mayalso define at least substantially the entirety of the crown occlusalsurface of its corresponding crown. This embodiment is particularlysuited for installation on each of the patient's first molars (bothupper first molars and both lower first molars). In this embodiment, thecrown mandibular advancement incline may be oriented so as to bedisposed at an angle of no more than about 20° relative to a plane whichis parallel with the occlusal plane of the dental arch on which thiscrown is installed.

The crown mandibular advancement incline associated with the subjectthird aspect may also be disposed on either the mesial or distal end ofthe crown. In one embodiment of this configuration, the crown mandibularadvancement incline is more specifically disposed at least generallywhere the crown occlusal surface and skirt would otherwise normallyintersect. The crown mandibular advancement incline also may be disposedon an extension which projects away from the annular crown skirt. Thecrown mandibular advancement incline in this case is thereby disposedbeyond the “oval” of the crown on the “free” end of this extension(e.g., at the end of this cantilever). Stated another way, the crownmandibular advancement incline in this case is disposed on an end of theextension which is opposite that which interfaces with the crown skirt.This particular embodiment may be effective at the more advanced stagesof the treatment of a Class II or III malocclusion by moving theactivating surface (e.g., the crown mandibular advancement incline) moremesially or distally to account for that amount of mesial or distalmovement of the mandible which has already been achieved, as the casemay be.

In each of the above described instances of a crown in accordance withthe subject third aspect of the present invention, there may be arelatively significant gap between the entirety of the crown occlusalsurface and the occlusal surface of the tooth on which the crown isdisposed within the subject dental arch. Conventional crowns contact atleast portions of the occlusal surface of the corresponding tooth. The“headroom” which may be incorporated into the crown of the subject thirdaspect may account for a desired positioning of the crown mandibularadvancement incline. In one embodiment, there is at least about a 1.5 mmminimum gap between the crown occlusal surface at its apex and theocclusal-most surface of the tooth over which this crown is disposedwhen installed within the mouth of the patient. This space may be filledwith an appropriate polymerizable material or may be left as an emptyspace when the crown is installed on the patient.

Those portions of the crown occlusal surface which do not define thecrown mandibular advancement incline may assume a variety of shapes orconfigurations in relation to the crown of the subject third aspect. Forinstance, these portions of the crown occlusal surface may besubstantially flat or planar, preferably such that the same are disposedat least generally in parallel relation with the occlusal of the dentalarch on which the crown is installed. These portions of the crownocclusal surface may also be anatomically-shaped so as to at leastgenerally approximate the underlying profile of the occlusal surface ofthe tooth on which the crown is installed.

A fourth aspect of the present invention is a crown which includes acrown occlusal surface which is disposable over an occlusal surface of atooth within a dental arch of a patient. An annular crown skirt extendsaway from this crown occlusal surface, toward the patient's gingiva wheninstalled on a tooth, and about this tooth as well. In this fourthaspect of the present invention, the crown occlusal surface is planar.

Various refinements exist of the features noted in relation to thesubject fourth aspect of the present invention. Further features mayalso be incorporated in the subject fourth aspect of the presentinvention as well. These refinements and additional features may existindividually or in any combination. A crown mandibular advancementincline frame may be separately attached to the crown occlusal surfaceof the crown of the subject fourth aspect (e.g., spot welded, brazed).Stated another way, the crown mandibular advancement incline frame andcrown in this case are separate parts, and are thereby not formed from asingle piece of material (i.e., there is at least one jointtherebetween). This particular crown mandibular advancement inclineframe includes first and second frame sections which are configured suchthat there is an acute angle therebetween. The first crown frame sectionis disposed on and is appropriately attached to the crown occlusalsurface (e.g., via one or more spot welds, via brazing) so that thesecond frame section extends away from both the first frame section andthe crown occlusal surface. The second frame section may therefore becharacterized as a crown mandibular advancement incline, and such may bea flat, planar surface. In one embodiment, the first frame sectionextends beyond the crown occlusal surface such that the second framesection is disposed at an interproximal location between two teethwithin the dental arch on which the crown is installed. In any case, thefirst frame section is mounted on the crown occlusal surface such thatthe second frame section at least generally extends away form the crownocclusal surface.

Enhancement of the interconnection between the crown and the crownmandibular advancement incline frame may be realized by incorporating atleast one, and more preferably a plurality of, apertures which extendthrough the entire occlusal-gingival extent of the first frame section.At least one of these apertures may be disposed so as to expose aportion of the crown occlusal surface on which the first frame sectionoverlies. Polymerized material may occupy the entire extent of any suchapertures. At least one aperture may also be disposed on that portion ofthe first frame section which extends beyond the crown occlusal surface.This may facilitate the directing of polymerizable material within thespace defined between the first and second frame sections. Polymerizablematerial may be captured within this space between the first and secondframe sections by having a pair of extensions which project from theopposite sides of the first frame section at least toward the “free” endof the second frame section or an apex of the second frame section.

A fifth aspect of the invention is embodied in a crown which includes acrown occlusal surface and an annular crown skirt which extendsgingivally therefrom when the crown is installed on a tooth in a givendental arch. At least substantially an entirety of, and more preferablythe entirety of, the crown occlusal surface is defined by a crownmandibular advancement incline. Preferably this crown mandibularadvancement incline is an at least substantially flat, planar surface.In one embodiment, this crown mandibular advancement incline is orientedso as to be disposed at an angle of no more than about 20° relative to areference plane which is parallel with the occlusal plane of the dentalarch on which the crown is installed. This makes the crown of thesubject fifth aspect particularly suited for installation on a patient'sfirst molars. Crowns in accordance with the subject fifth aspect may beinstalled on both upper first molars and both lower first molars foraffecting mandibular advancement. The crown mandibular advancementinclines installed on the upper first molars will engage with theircorresponding crown mandibular advancement incline installed on theopposing lower first molar to affect mandibular advancement.

Various combinations of the casting forms and crowns/bands may beutilized to install a mandibular advancement incline on the same side ofthe upper and lower arches of the patient to cooperate for affectingmandibular advancement. For instance, the casting form with polymerizedmaterial therein may be fixed to one side of the patient's upper dentalarch, and any of the above-noted crowns/band having a mandibularadvancement incline associated therewith may be installed on thepatient's lower dental arch to cooperate therewith to affect mandibularadvancement, or vice versa. In addition, a casting form with one of theabove-noted crowns or band and polymerized material therein may be fixedto one side of the patient's upper dental arch, and any of theabove-noted crowns or band having a mandibular advancement inclineassociated therewith may be installed on the patient's lower dental archto cooperate therewith to affect mandibular advancement, or vice versa.Moreover, a casting form with polymerized material therein may be fixedto one side of the patient's upper dental arch, and another casting formwith polymerized material therein may be fixed to one side of thepatient's lower dental arch to cooperate therewith to affect mandibularadvancement. Finally, any of the above-noted crowns or band having amandibular advancement incline associated therewith may be installed onthe patient's upper dental arch, and any of the above-noted crowns orband having a mandibular advancement incline associated therewith may beinstalled on the patient's lower dental arch to cooperate therewith toaffect mandibular advancement.

A sixth aspect of the present invention is generally directed towardproviding enhanced occlusal support during movement of a patient'smandible. In this regard, an appropriate mandibular advancer willtypically be installed on both sides of the patient's upper and lowerdental arches. This may and likely will cause the patient to be unableto seat the upper dental arch entirely on the lower dental arch (i.e.,engagement of opposing mandibular advancers will keep the upper andlower dental arches in spaced relation). One way to address thiscondition is to install at least one crown having an enhancedocclusal-gingival extent (in relation to conventional crowns and how thesame typically are disposed relative to the gingiva) on each side of thepatient's upper and/or lower dental arch, typically at a location whichis mesial of the mandibular advancer(s) that is installed on the sameside of the same dental arch. In any case, a space exists between theocclusal surface of the tooth on which the crown is installed and theinterior of the occlusal surface of the crown (e.g., in the mannercontemplated by the seventh aspect discussed below). The occlusalsurface of this “taller” crown will at least at some point in timeduring treatment engage a tooth disposed on the opposing dental arch toprovide occlusal support at a location other than that where mandibulartreatment forces are being generated (e.g., other than where opposingmandibular advancers are engaged).

A seventh aspect of the present invention is generally directed to acrown which may be used in at least some aspect of mandibular movementtreatment/therapy. This particular crown has an enhancedocclusaal-gingival extent in that its crown occlusal surface is disposedin spaced relation to the occlusal surface of the underlying tooth onwhich the crown is installed, even though its gingival extreme isdisposed at or below/under the patient's gingiva. In one embodiment, theminimum vertical extent of this space is at least about 1.5 mm asmeasured along the tooth-long axis. That is, there is at least about a1.5 mm space between each point on the occlusal surface of the tooth andthat point on the interior of the occlusal surface of the crown which isdisposed therebeyond along a reference axis which is parallel with thetooth-long axis.

Various refinements exist of the features noted in relation to thesubject seventh aspect of the present invention. Further features mayalso be incorporated in the subject seventh aspect of the presentinvention as well. These refinements and additional features may existindividually or in any combination. For instance, the crown of thesubject seventh aspect may include an mandibular advancement incline ofany of the types noted above in relation to the third and fifth aspectsnoted above. Another surface for providing an active force formandibular advancement may be the transition section between the crownocclusal surface and the crown skirt (e.g., a generally convexly arcuatesurface on both the mesial and distal of the crown). Alternatively, thecrown of the subject sixth aspect may be used for providing enhancedocclusal support in the manner addressed by the above-noted sixthaspect.

An eighth aspect of the present invention is directed to a cap and bandwhich are interconnected in a certain manner to define a mandibularadvancer. The cap includes a cap occlusal surface, a cap skirt, and atleast one “active” surface for affecting mandibular advancement (e.g., amandibular advancement incline). The occlusal-gingival extent of the capis less than that of the occlusal-gingival extent of the exposed enamelof the tooth on which the cap is mounted (e.g., the gingival edge of thecap is disposed in spaced relation to the patient's gingiva). One wireextends from each of the buccal and lingual sides of the cap forattachment to the band. In this regard, the band includes appropriatestructure on each of its buccal and lingual sides for interfacing withthese wires to orient the cap on the tooth and interconnect the cap withthe band.

Various refinements exist of the features noted in relation to thesubject eighth aspect of the present invention. Further features mayalso be incorporated in the subject eighth aspect of the presentinvention as well. These refinements and additional features may existindividually or in any combination. The cap occlusal surface may bedisposed in spaced relation to the occlusal surface of the tooth onwhich the cap is mounted. Those spacings discussed above in relation tothe seventh aspect may be utilized by the subject eighth aspect as well.With regard to the “active” surface of the cap, any of the mandibularadvancement inclines discussed above in the third and fifth aspects forcrowns may be incorporated into the cap associated with the subjecteighth aspect. Another surface for providing an active force formandibular advancement may be the transition section between the capocclusal surface and the cap skirt (e.g., a generally convexly arcuatesurface on both the mesial and distal of the cap). The components of thesubject eighth aspect could also be used to provide the functionality ofthe sixth aspect discussed above.

Both of the wires may include a first section which is at leastgenerally occlusally-gingivally disposed, and a second section which isat least generally mesially-distally disposed. One of these wires mayinterface with a buccal tube disposed on and attached to the buccal sideof the band. The other of these wires may be disposed under a catchdisposed on and attached to the lingual side of the band. A ligatingtube may also be disposed on and attached to the lingual side of theband for using a ligature wire to further secure the wire whichinterfaces with the catch.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

FIG. 1A is a perspective view of a lower dental arch of a patient withone embodiment of a pair of crown mandibular advancers disposed onopposite sides of the lower dental arch.

FIG. 1B is a perspective view of an upper dental arch of a patient withone embodiment of a pair of casting form mandibular advancers disposedon opposite sides of the upper dental arch.

FIG. 2 is a perspective view of a casting form used by the embodiment ofthe casting form mandibular advancer presented in FIG. 1B.

FIG. 3 is a side view of the casting form of FIG. 2.

FIG. 4 is a cutaway side view of one side of an upper dental arch of apatient with the embodiment of the casting form mandibular advancerpresented in FIG. 1B being shown in cross-section thereon.

FIG. 5 is a perspective view of the embodiment of the crown mandibularadvancer presented in FIG. 1A.

FIG. 6 is a perspective, cross-sectional view of the embodiment of thecrown mandibular advancer presented in FIG. 5.

FIG. 7 is a cutaway side view of one side of upper and lower dentalarches of a patient with another embodiment of a casting form mandibularadvancer being installed on the upper dental arch and with theembodiment of the casting form mandibular advancer presented in FIG. 4being installed on the lower dental arch.

FIG. 8 is a cutaway side view of one side of upper and lower dentalarches of a patient with another embodiment of a casting form mandibularadvancer being installed on the upper dental arch and with theembodiment of the casting form mandibular advancer presented in FIG. 4being installed on the lower dental arch.

FIG. 9 is an exploded, perspective view of an embodiment of acombination casting form/crown mandibular advancer.

FIG. 10 is a perspective view of the crown assembly utilized by theembodiment of the combination casting form/crown mandibular advancerpresented in FIG. 9.

FIG. 11A is a side view of the crown from the crown assembly of FIG. 10.

FIG. 11B is a perspective view of the interior of the crown from thecrown assembly of FIG. 10.

FIG. 12 is a perspective view of the crown mandibular advancementincline frame from the crown assembly of FIG. 10.

FIG. 13 is a cross-sectional view of the embodiment of the combinationcasting form/crown mandibular advancer presented in FIG. 9.

FIG. 14 is an exploded, perspective view of another embodiment of acombination casting form/crown mandibular advancer.

FIG. 15 is a perspective view of another embodiment of a crownmandibular advancer.

FIG. 16 is a perspective view of another embodiment of a crownmandibular advancer.

FIG. 17A is a perspective view of an embodiment of a band mandibularadvancer.

FIG. 17B is a top view of the band mandibular advancement incline frameused by the band mandibular advancer presented in FIG. 17A.

FIG. 18 is a side view of the embodiment of the band mandibular advancerpresented in

FIG. 17A is when installed on a tooth.

FIG. 19 is a perspective view of another embodiment of a crownmandibular advancer.

FIG. 20A is a side view, looking toward the lingual, of the crownmandibular advancer of

FIG. 19 when installed on both the upper and lower dental arches of apatient.

FIG. 20B is an end view, looking from the distal and towards the mesial,of the arrangement illustrated in FIG. 20A.

FIG. 21 is a perspective view of another embodiment of a crownmandibular advancer.

FIG. 22 is a cutaway view of the crown mandibular advancer of FIG. 21.

FIG. 23 is a perspective view of another embodiment of a crownmandibular advancer.

FIG. 24 is a cutaway view of the crown mandibular advancer of FIG. 23.

FIG. 25 is a perspective view of a crown having an enhancedocclusal-gingival extent.

FIG. 26 is a cutaway side view of one side of upper and lower dentalarches of a patient with one configuration of crown-based mandibularadvancers and the crown of FIG. 25 for providing enhanced occlusalsupport.

FIG. 27 is a cutaway side view of one side of upper and lower dentalarches of a patient with another configuration of crown-based mandibularadvancers and the crown of FIG. 25 for providing enhanced occlusalsupport.

FIG. 28 is a perspective view of a cap/band mandibular advancer .

FIG. 29 is another perspective view of the cap/band mandibular advancerof FIG. 28.

FIG. 30 is another perspective view of the cap/band mandibular advancerof FIG. 28.

FIG. 31 is an occlusal view of the cap/band mandibular advancer of FIG.28.

DETAILED DESCRIPTION OF THE INVENTION

The present invention will now be described in relation to theaccompanying drawings which at least assist in illustrating its variouspertinent features. FIGS. 1A-B illustrate a mandible 4 and maxilla 24 ofa patient. The mandible 4 includes a lower dental arch 6 having twosides—one side using an “a” designation for its corresponding teeth andwith the opposite side using a “b” designation for its correspondingteeth. Each side of the lower dental arch 6 includes the following teethwhich extend from a lower gingiva 22 of the patient: a lower central 8,a lower lateral 10, a lower cuspid 12, a lower first bicuspid 14, alower second bicuspid 16, a lower first molar 18, and a lower secondmolar 20. The maxilla 24 includes an upper dental arch 26 having twosides—one side using an “a” designation for its corresponding teeth andwith the opposite side using a “b” designation for its correspondingteeth. Each side of the upper dental arch 26 includes the followingteeth which extend from an upper gingiva 42 of the patient: an uppercentral 28, an upper lateral 30, an upper cuspid 32, an upper firstbicuspid 34, an upper second bicuspid 36, an upper first molar 38, andan upper second molar 40. Teeth on the “a” side of the lower arch dentalarch 6 interface with teeth on the “a” side of the upper dental arch 26,while teeth on the “b” side of the lower dental arch 6 interface withteeth on the “b” side of the lower dental arch 26. Both the lower dentalarch 6 and the upper dental arch 26 have an orthodontic arch 44installed on the lingual side thereof (and therefore a lingual arch 44),and orthodontic brackets 48 installed on the buccal side thereof with anarch wire 46 passing through the various brackets 48.

A mandibular advancement system 50 is disclosed herein which utilizes apair of mandibular advancers 52 which are installed on opposite sides ofthe lower dental arch 6. The system 50 further utilizes another pair ofmandibular advancers 52 which are installed on opposite sides of theupper dental arch 26. Those mandibular advancers 52 which are installedon opposite sides of the upper dental arch 26 interface with anmandibular advancer 52 which is on the same side, but on the lowerdental arch 6, to affect mesial or distal advancement of the mandible 4,depending upon the positioning of the “active” surfaces of theseadvancers 52. Preferably, each such “active” surface is flat or planarwith an area of at least about 13 mm², is disposed at an angle relativeto an occlusal plane of a dental arch on which the subject mandibularadvancer 52 is disposed, and further is disposed to extend at leastsubstantially across or perpendicular to the major axis of such dentalarch. Various configurations for the mandibular advancers 52 arepresented herein. Each of these various mandibular advancers 52 may beutilized in an mandibular advancement system 50. Although the acceptednomenclature of the adult teeth have been presented herein and will beused in the description of the mandibular advancers 52, it should beappreciated that these mandibular advancers 52 are applicable tochildren. Different nomenclature is commonly used to describe a child'steeth. Nonetheless, the advancers 52 will be installed on the tooth orteeth of a child which positionally correspond to those adult teethidentified herein.

Details of one embodiment of a mandibular advancer 52 are presented inFIGS. 1B and 4, with certain components thereof being illustrated inFIGS. 2-3. The mandibular advancer 52 ^(ii) of FIGS. 1B and 4 includes acasting form 54 which functions as a “bathtub” of sorts and which isalso illustrated in FIGS. 2-3. Generally a “flowable” material isdisposed within the casting form 54 such that this material may be“molded” to conform to at least two teeth of a patient, and thereafter“cured” (e.g., polymerized) into an at least substantially rigid formsuch that the mandibular advancer 52 ^(ii) s available for theapplication of mandibular advancement forces to the patient. In thisregard, a casting form occlusal surface 66, a casting form buccal skirt78, a casting form lingual skirt 82, and a casting form mandibularadvancement incline 86 collectively define a hollow repository orcontainment space 88 in which this “flowable” material may be disposedthrough the “open” side of the casting form which is disposed oppositethe casting form occlusal surface 66.

The casting form mandibular advancement incline 86 is disposed on afirst end of the casting form 54. This incline 86 is an at leastsubstantially flat, planar surface and is/defines the “active” surfaceof an mandibular advancer 52 which incorporates such a casting form 54.That is, the incline 86, or an underlying material/structure disposed inat least substantially parallel and interfacing relation therewith,engages the “active” surface of a mandibular advancer 52 disposed on thesame side of the opposing dental arch to affect mandibular advancement.In one embodiment, the size of the incline 86 has a length which iswithin a range of about 5 mm to about 7 mm and a width which is within arange of about 3 mm to about 5 mm. FIG. 1B illustrates that mesialadvancement of the mandible 4 may be affected by having the mandibularadvancer 52 ^(ii) installed on the upper dental arch 26 and by havingthe casting form mandibular advancement incline 86 project at leastgenerally mesially. Distally directed advancement of the mandible 4, ora retraction of the mandible 4, could be affected by having themandibular advancer 52 ^(ii) installed on the upper dental arch 26 andby having the casting form mandibular advancement incline 86 project atleast generally distally. Similarly, the mandibular advancer 52 ^(ii)could be installed on the lower dental arch 6 to affect mesialadvancement of the mandible 4 (by having the casting form mandibularadvancement incline 86 project at least generally distally) or to affectdistal advancement of the mandible 4 (by having the casting formmandibular advancement incline 86 project at least generally mesially).

The casting form mandibular advancement incline 86 is disposed at leastsubstantially across or perpendicular to the major axis of the dentalarch on which it is disposed (i.e., extending from the buccal to thelingual). Moreover, the incline 86 is disposed at an angle of about 20degrees relative to vertical in the embodiment of the mandibularadvancer 52 ^(i) presented in FIGS. 1B and 4. Other angulardispositionings of the casting form mandibular advancement incline 86may be utilized to affect mandibular movement by the desiredcamming-like action (e.g., 45 degrees). However, the noted 20 degreeangle is believed to reduce the potential for the casting formmandibular advancement incline 86 becoming inadvertently disengaged withthe “active” surface of its opposing mandibular advancer 52 (the crownmandibular advancement incline 112 in the case where the mandibularadvancer 52 ^(ii) s used in combination with the mandibular advancer 52^(i), as presented in FIGS. 1A-B) during treatment to affect mandibularadvancement. When installed on a given dental arch, this then disposesthe casting form mandibular advancement incline 86 at an angle to theocclusal plane of the subject dental arch. In the noted embodiment thecasting form mandibular advancement incline 86 will be disposed at anangle of about 70 degrees relative to this particular occlusal plane.Unless otherwise noted herein, the “active” surface of each of themandibular advancers 52 addressed herein will be oriented similarly tothe casting form mandibular advancement incline 86 when mounted on thesubject dental arch.

The casting form 54 shown in FIGS. 1B and 2-4 includes a second end 62which is disposed opposite the first end 58 having the casting formmandibular advancement incline 86. These ends 58 and 62 are separated bya distance such that the casting form 54 will overlie at least twoentire teeth of a patient, and possibly at least part of a third tooth,when the advancer 52 ^(ii) s installed on the subject dental arch. Thesecond end 62 curves from the casting form buccal skirt 78 to thecasting form lingual skirt 82 of the casting form 54 for purposes ofextending any mandibular advancer 52 which uses the casting form 54 tocover the occlusal surfaces of adjacent teeth in the subject dentalarch, to assist in gaining adequate fixation, and to incorporate theseteeth in an anchorage unit, as a means of resistance, in order to applyforces sufficient to advance the mandible 4. In one embodiment, thisparticular curvature is defined by a radius. Typically the second end 62of the casting form 54 is disposed directly on one of the teeth of thedental arch of the patient on which the casting form 54 is installed.Stated another way, the casting form 54 is typically not installed suchthat its second end 62 “extends around” one of the teeth of the dentalarch of the patient on which the casting form 54 is installed.

The casting form 54 may be disposed between a pair of adjacent teethwithin the dental arch of a patient on which the casting form 54 isinstalled. In this regard, the casting form 54 may include an extension90 which is disposed on its first end 58 and which extends furthergingivally from the gingival extreme of the casting form mandibularadvancement incline 86. This extension 90 is configured so as to“straddle” the dental arch on which the casting form 54 is installed. Agenerally u-shaped aperture 92 defined by a pair of spaced-apart prongs94 provides this function. In the illustrated embodiment, theocclusal-gingival extent of the casting form 54 at its first end 58 withthe extension 90 thereon is greater than the occlusal-gingival extent ofadjacent portions of both the casting form buccal skirt 78 and thecasting form lingual skirt 82. This need not always be the case. Forinstance, the first end 58 of the casting form 54 may have the sameocclusal-gingival as that of the adjacent portion of the casting formbuccal skirt 78 and/or the casting form lingual skirt 82.

The casting form buccal skirt 78 and the casting form lingual skirt 82are disposed in spaced relation. In one embodiment the casting formbuccal skirt 78 and the casting form lingual skirt 82 are sufficientlyspaced such that the casting form 54 may extend along at least a portionof the lingual and/or buccal sides of the dental arch on which thecasting form 54 is installed. Material within the casting form 54 maythen be disposed between the casting form 54 and at least part of theselingual and/or buccal surfaces of the dental arch. This may serve toincrease the “robustness” of the installation of the casting form 54 onthe subject dental arch. It may also be desirable for the casting form54 to cover or partially/totally encapsulate or encase orthodonticarmamentarium installed on these lingual and/or buccal surfaces of thesubject dental arch. Further increases of the “robustness” of theinterconnection of the casting form 54 with the subject dental arch maybe realized by having the casting form 54 cover or encapsulate acorresponding lingual arch 44.

The entire longitudinal extent of the casting form 54 need not extendalong the lingual and/or buccal sides of the corresponding dental archto the same occlusal-gingival extent. One or both of the casting formbuccal skirt 78 and the casting form lingual skirt 82 may have adifferent occlusal-gingival extent at one or more places between thefirst end 58 of the casting form 54 and the second end 62 of the castingform 54. In the illustrated embodiment, a first buccal skirt section 79which extends from the first end 58 has a larger occlusal-gingivalextent than a second buccal skirt section 80 which extends from an endof this first section 79 to the second end 62 of the casting form 54.The casting form lingual skirt 82 may be similarly configured. This“two-tiered” occlusal-gingival extent provides the benefit of greaterflexibility with the facility to fit the casting form 54 over severalteeth with the depth of the casting form buccal skirt 78 and/or castingform lingual skirt 82 to be varied according to the contours of thecorresponding teeth, and of any lingual or buccal attachments (e.g.,brackets, wires, or tubes) which may be fitted as part of an orthodonticappliance.

Other contours may be employed on one or both of the casting form buccalskirt 78 and the casting form lingual skirt 82 of the casting form 54.Significant flexibility is provided as to the actual configuration ofboth the casting form buccal skirt 78 and the casting form lingual skirt82 by making the casting form 54 from materials (e.g., thermoformplastics) which allow orthodontic laboratory personnel or orthodonticpractitioners to customize the casting form 54 to the needs of theparticular treatment application and/or patient by cutting the castingform 54 into the desired profile. For instance, one or more enclosedapertures (i.e., holes) or open apertures (i.e., those which interfacewith the gingival edge of the casting form 54) may be cut in one or bothof the casting form buccal skirt 78 and the casting form lingual skirt82 so as to keep the casting form 54 from covering certain orthodonticarmamentarium when the casting form 54 is installed on the subjectdental arch of the patient (not shown).

Engagement of the casting form mandibular advancement incline 86 by the“active” surface of the mandibular advancer 52 disposed on the opposingdental arch is used to affect mesial or distal advancement of themandible 4 by what may be characterized as a “camming-like” action asnoted. Typically the patient will have to move the mandible 4 in orderto establish this engagement. In this regard, the casting form occlusalsurface 66 of the casting form 54 is contoured to facilitate thisengagement. The casting form occlusal surface 66 includes a firstsection 70 and a second section 74 that are disposed in differentorientations. The first section 70 of the casting form occlusal surface66 is at least substantially flat or planar, and is intended to bedisposed at least generally parallel with the occlusal plane of thedental arch when the casting form 54 is installed thereon. The opposingmandibular advancer 52 may “slide” on this first section 70 to engagethe “active” surfaces of the corresponding mandibular advancers 52. Thesecond section 74 of the casting form occlusal surface 66 is also atleast substantially flat or planar. However, the end of the secondsection 74 corresponding with the second end 62 of the casting form ismore gingivally disposed than the end of the second section 74 which isadjacent to the first section 70. That is, the second section 74 slantsgingivally progressing from the first section 70 toward the second end62 of the casting form 54. Configuring the second section 74 in thismanner provides the benefit of a wedge-shaped occlusal casting form 54,which is thicker at the first section 70 than at the second section 74,and thinner at the second end 62. This is to accommodate the naturalcontours of the opposing teeth when the jaws are closed. Consider thecase when the casting form 54 is installed on the upper dental arch 26.When the teeth are slightly apart with the mandible 4 and maxilla 24slightly open, the space between the lower first molar 18 and upperfirst molar 38 and the space between the lower second molar 20 and theupper second molar 40, is slightly less than the space between the lowerfirst bicuspid 14 and the upper first bicuspid 34 (in a child, theseteeth are more commonly referred to as the lower and upper firstdeciduous molars, respectively, or the “D”) and the space between thelower second bicuspid 16 and the upper second bicuspid 36 (in a child,these teeth are more commonly referred to as the lower and upper seconddeciduous molars, respectively, or the “E”). The wedge-shaped profile ofthe casting form 54, when installed on the upper dental arch 26, isdesigned to accommodate this feature as it is thinner(occlusally-gingivally) posteriorly and thicker (occlusally-gingivally)anteriorly.

As noted above, the casting form 54 is formed from a material which maybe cut by orthodontic laboratory personnel or orthodontic practitionersto customize the configuration of the casting form 54 to the dental archof the patient on which the casting form 54 will be installed. Moreover,preferably the material from which the casting form 54 is made will also“cross-link” with the flowable material disposed therein when the sameis cured. That is, the flowable material which is disposed within therepository 88 of the casting form 54 is cured to a desired degree ofrigidity to define a polymerized material 98 within the casting form 54,and which is illustrated in FIG. 4 and which will be discussed in moredetail below. This “curing” of the flowable material into thepolymerized material 98 preferably chemically interconnects thepolymerized material 98 with the casting form 54, although it may bepossible to not have a cross-linking between the casting form 54 and thepolymerized material 98 therewithin. In one embodiment, the casting form54 is made from thermoform plastics and the flowable material is atraditional/customary composite resin.

Installation of the mandibular advancer 52 ^(ii) utilizing the castingform 54 discussed above may be affected in a number of different mannerson the subject dental arch. Consider the example presented in FIG. 1Bwhere the mandibular advancer 52 ^(ii) s installed on the upper dentalarch 26. One way to install the mandibular advancer 52 ^(ii) involvesthe use of a stone casting. In this case a stone casting is made of theupper dental arch 26 of the patient at issue. This will typically bedone “chair side” by an orthodontic practitioner. The orthodonticpractitioner will then typically send the stone casting to anorthodontic laboratory for production of a customized mandibularadvancer 52 ^(ii) for each of the two sides of the upper dental arch 26.One or more orthodontic appliances may need to be attached to thelingual and/or buccal sides of the dental arch 26 to affect the desiredorthodontic treatment. Portions of the casting form buccal skirt 78and/or the casting form lingual skirt 82 of the casting form 54 may betrimmed to accommodate exposure of one or more of these orthodonticappliances when the mandibular advancer 52 ^(ii) s installed on theupper dental arch 26. In any case, an appropriate release agent is firstapplied to the occlusal, lingual, and buccal surfaces of the stonecasting of the upper dental arch 26 in the region where the casting form54 is to be installed. An appropriate flowable material is disposedwithin the casting form 54 and the same is then disposed over the stonecasting of the upper dental arch 26. The extension 90 straddles thestone casting of the upper dental arch 26 such that the opposing prongs94 are disposed on the buccal and lingual sides of the stone castingbetween the stone casting of the upper second bicuspid 36 and the upperfirst bicuspid 34. Both the stone casting of the upper second bicuspid36 and the stone casting of the upper first molar 38 are totally coveredby the casting form 54 with the flowable material therein. Only aportion of the stone casting of the upper second molar 40 is covered bythe casting form 54 in that the second end 62 of the casting form 54engages an occlusal surface of the stone casting of the upper secondmolar 40. However, the casting form 54 could be configured to cover theentirety of the second molar 40 as well (not shown).

Once on the stone casting of the upper dental arch 26, the casting form54 is seated thereon into the desired position. Preferably this involvesdisposing the first section 70 of the casting form occlusal surface 66in at least generally, and more preferably in at least substantiallyparallel relation with the occlusal plane of the stone casting of theupper dental arch 26. This is usually only visually determined by theorthodontic laboratory technician. At least part of the casting formmandibular advancement incline 86 will be occlusally-gingivally alignedwith at least a mesial portion of the upper second bicuspid 36. However,with the casting form mandibular advancement incline 86 typically beingdisposed at an angle of about 20 degrees relative to vertical, at leastabout 7 mm of the mesio-distal extent of the upper second bicuspid 36will typically underlie the first section 70 of the casting form 54. Atleast a mesial portion of the upper first molar 38 may underlie thefirst section 70 of the casting form occlusal surface 66 of the castingform 54 as well.

At least a partial curing of the flowable material within the castingform 54 occurs while the casting form 54 is installed on the stonecasting of the upper dental arch 26. Curing may be affected simply bythe passage of time and with the casting form 54 and the stone castingof the upper dental arch 26 being exposed to ambient conditions. Othertechniques for at least partially curing the flowable material while thecasting form 54 is mounted on the stone casting of the upper dental arch26 may be utilized as well. One or more light sources may be directedat/through the casting form 54 to affect at least a partial curing ofthe flowable material which is retained between the casting form 54 andthe stone casting of the upper dental arch 26. Once the flowablematerial has cured to the degree where it will at least substantiallyretain its shape within the casting form 54, the casting form 54 and theat least partially cured flowable material therein may be collectivelyremoved from the stone casting of the upper dental arch 26 due to theuse of the above-noted release agent. Completion of the curing of theflowable material may then be completed, such as by disposing thecasting form 54 and the at least partially cured flowable materialwithin an appropriate oven. Exactly how the flowable material is curedis not essential to the manufacture/use of a mandibular advancer 52which utilizes a casting form 54.

Curing of the flowable material to the desired degree provides apolymerized material 98 within the casting form 54 (FIG. 4). Thepolymerized material 98 is sufficiently rigid so as to be able towithstand the forces which will be used to affect advancement of themandible 4. That is, the polymerized material 98 is sufficiently rigidand strong to withstand the forces of occlusion of the teeth withoutdistortion or breakage. The surface in contact with the teeth isaccurately moulded to the teeth, so that a suitable dental adhesive canbe used to fix the casting forms 54 to the teeth.

The mandibular advancer 52 ^(ii), which has been formed in theabove-described manner, is now ready for installation on the patient.The orthodontic practitioner applies an appropriate orthodontic bondingsystem to least a portion of those surfaces of the mandibular advancer52 ^(ii), and preferably the entirety thereof, which will interface withthe upper dental arch 26 of the patient when installed thereon. Theorthodontic practitioner then simply positions the mandibular advancer52 ^(ii) on the upper dental arch 26 of the patient in the same positionas the same was formed on the stone casting thereof in the above-notedmanner. As can be seen in FIG. 4, the extension 90 of the casting form54 is positioned between the upper first bicuspid 34 and the uppersecond bicuspid 36. The polymerized material 98 at least substantiallyconforms to the occlusal surface of the upper second bicuspid 36, theocclusal surface of the upper first molar 38, and part of the occlusalsurface of the upper second molar 40. The polymerized material 98 alsoconforms to the spacing between the upper second bicuspid 36 and thecasting form mandibular advancement incline 86, the spacing between theupper second bicuspid 36 and the upper first molar 38, and the spacingbetween the upper first molar 38 and the upper second molar 40.Furthermore, the polymerized material 98 extends along at least part ofboth the buccal and lingual surfaces of the entire mesio-distal extentof the upper second bicuspid 36 and the upper first molar 38, as well aspart of the mesio-distal extent of the upper second molar 40. The“active” surface of the mandibular advancer 52 ^(ii) is the casting formmandibular advancement incline 86. However, the underlying polymerizedmaterial may also actually define the “active” surface of the mandibularadvancer 52 ^(ii) should the material of the casting form mandibularadvancement incline 86 “wear away” during treatment.

The mandibular advancer 52 ^(ii) can also be totally assembled andinstalled “chair side” by the orthodontic practitioner and at leastgenerally in the above-noted manner. At least those teeth which willinterface with the mandibular advancer 52 ^(ii) first must besufficiently prepared (e.g., cleaned) so that a suitable bond can beestablished therewith by the advancer 52 ^(ii). The casting form 54 witha flowable material therein is disposed directly on the desired teeth ofthe upper dental arch 26. The flowable material in this instance alsoserves to establish a bond directly with the teeth that interfacetherewith. That is, the mandibular advancer 52 ^(ii) in this case is notremoved from the upper dental arch 26 for curing. Instead, the flowablematerial is totally cured within the mouth of the patient to the desireddegree by using an appropriate light source or the like. In this regard,it is desirable to form the casting form 54 from a material which is atleast partially transparent. Another embodiment of an mandibularadvancer 52 which may be used by the mandibular advancement system 50 ispresented in FIGS. 1A and 5-6. The mandibular advancer 52 ^(i) of FIGS.1A and 5-6 includes a crown 102 which is installed over a tooth in thesubject dental arch. In the mandibular advancement system 50 illustratedin FIG. 1A, the crown 102 of each mandibular advancer 52 ^(i) isinstalled on the lower second bicuspid 16 on each side of the lowerdental arch 6. The crown 102 generally includes a crown occlusal surface104 and an annular crown skirt 116 which extends away from the crownocclusal surface 104 and toward the corresponding gingiva when the crownis installed over a tooth within a given dental arch. A crown mandibularadvancement incline 112 is disposed on an “end” 108 of the crown 102which projects either mesially or distally when the crown 102 isinstalled over a tooth in the subject dental arch. The crown mandibularadvancement incline 112 projects distally in the configuration presentedin FIG. 1A. The “active” surface of the mandibular advancer 52 ^(i) isthe crown mandibular advancement incline 112, and in one embodiment suchis an at least substantially flat, planar surface.

The crown occlusal surface 104, the crown mandibular advancement incline112, and the crown skirt 116 are integrally formed. Stated another way,the crown occlusal surface 104, the crown mandibular advancement incline112, and crown skirt 116 are formed from a single piece of material suchthat there is no joint of any kind between any of these components.Materials which are commonly used to make conventional crowns may beused to make the crowns 102 here as well, such as stainless steel,titanium, gold, and aluminum. Other materials such as vacuum-formedplastics such as polycarbonate, acrylic, styrene, buturate, and vinylsmay be used as well for the crowns 102. These materials would also beapplicable for making the casting form 54 by vacuum-forming techniques.

As can be seen in FIG. 6, the crown 102 is “taller” than conventionalcrowns. When the crown 102 is installed over the desired tooth (a lowersecond bicuspid 16 in the case of the installation of the mandibularadvancer 52 ^(i) presented in FIGS. 1A and 6), there is a space 120between the occlusal surface of this tooth and the crown occlusalsurface 104. In one embodiment, the minimum vertical extent of thisspace 120 is about 1.5 mm at its occlusal-most extreme or at the apex ofthe incline 112, and may be as much as about 4 mm at its occlusal-mostextreme (both measured relative to an occlusal-most surface of the tooth16 or the “peaks” of the subject tooth). A suitable orthodontic bondingsystem may be used to fixedly mount the crown 102 over/onto the subjecttooth. These types of materials are sufficiently rigid when cured toenhance the support of the crown mandibular advancement incline 112.That is, an amount of orthodontic bonding system material may bepositioned within the crown 102 before installing the same over thesubject tooth such that the entirety of the space 120 is occupied bythis orthodontic bonding system material when the crown 102 is installedover the subject tooth. Alternatively, the space 120 may remain as an“air gap” between the crown occlusal surface 104 and the occlusalsurface of the tooth on which the crown 102 is mounted.

The existence of the space 120 facilitates the dispositioning of thecrown mandibular advancement incline 112 in a desired position wheninstalled over its corresponding tooth (e.g., disposed at an angle ofabout 70 degrees relative to a plane which is parallel with the occlusalplane associated with the dental arch having the tooth over which thecrown 102 is installed). In this regard and as can be seen in FIG. 6,the gingival-most extreme of the crown mandibular advancement incline112 initiates where the tip of the corresponding tooth begins to extendinwardly toward its tooth-long axis and is disposed in at leastgenerally parallel relation therewith. The incline 112 continues toextend occlusally beyond the occlusal surface of the tooth 16. In oneembodiment, the length of the crown mandibular advancement incline 112is within a range of about 3 mm to about 5 mm, the width of the crownmandibular advancement incline 112 is within a range of about 5 mm toabout 7 mm, and/or has an area within a range of about 13 mm² to about15 mm².

Each of the two mandibular advancers 52 ^(ii) on the upper dental arch26 cooperate with their own mandibular advancer 52 ^(i) on the lowerdental arch 6 in order to affect mesial advancement of the mandible 4 inthe particular configuration illustrated in FIGS. 1A-B. The casting formmandibular advancement incline 86 of the mandibular advancer 52 ^(ii)disposed on the “a” side of the upper dental arch 26, or the similarlycontoured polymerized material 98 thereunder, cams relative to the crownmandibular advancement incline 112 of the mandibular advancer 52 ^(i)disposed on the “a” side of the lower dental arch 6 when disposed ininterfacing relation therewith. Similarly, the casting form mandibularadvancement incline 86 of the mandibular advancer 52 ^(ii), or thesimilarly contoured polymerized material 98 thereunder, disposed on the“b” side of the upper dental arch 26 cams relative to the crownmandibular advancement incline 112 of the mandibular advancer 52 ^(i)disposed on the “b” side of the lower arch 6 when disposed ininterfacing relation therewith. Again, this may require the patient to“slide” his/her mandible 4 forward or mesially. This sliding movement isagain facilitated by disposing the first section 70 of the casting formocclusal surface 66 in at least generally parallel relation with theocclusal plane of the upper dental arch 6 such that the crown occlusalsurface 104 of the corresponding crown 102 may slide thereon toestablish the noted camming engagement for affecting mesial mandibularmovement.

In the configuration illustrated in FIG. 1A, the mandibular advancer 52^(i) includes only the crown 102 with its various features. A variationwould be to use the crown 102 in combination with the casting form 54discussed above in relation to the mandibular advancer 52 ^(ii), and inthe generally same manner as will be discussed below in relation to themandibular advancer 52 ^(v) of FIGS. 9-13. Generally, the crown 102would be installed over a tooth in the subject dental arch in theabove-described manner, and the casting form 54 would be disposed overthe crown 102 and at least one additional tooth in the subject dentalarch so as to dispose the casting form mandibular advancement incline 86and crown mandibular advancement incline 112 at least generallyproximate to each other and at least in generally parallel relation, andmore preferably actually in interfacing relation. The flowable materialwould be cured with the crown 102 being within the casting form 54 toappropriately interconnect the same.

Another embodiment of an mandibular advancer 52 is presented in FIG. 7.Referring now to FIG. 7, a mandibular advancer 52 ^(ii) of the typediscussed above is installed on each side of the lower dental arch 6. Inthis case, however, the corresponding casting forms 54 are installedover only two teeth within the lower dental arch 6, namely the lowerfirst bicuspid 14 and the lower second bicuspid 16. Moreover, thecasting form mandibular advancement incline 86 of each of thesemandibular advancers 52 ^(ii) is disposed to project at least generallydistally, whereas in the configuration discussed above in relation toFIG. 1B the inclines 86 projected at least generally mesially.

A pair of mandibular advancers 52 ^(ii) are installed on both sides ofthe upper dental arch 26 and as illustrated in FIG. 7. Each of thesemandibular advancers 52 ^(iii) includes a casting form 54′ withpolymerized material therein 98. A “prime” designation is used for thecasting forms 54′ of the mandibular advancers 52 ^(iii) since they havea larger occlusal-gingival extent compared to the casting forms 54 usedby the mandibular advancer 52 ^(ii) (the dashed line in FIG. 7representing the location of the casting form occlusal surface 66 of thecasting form 54 of the mandibular advancer 52 ^(ii)). The mandibularadvancers 52 ^(iii) with their modified casting forms 54′ generallyaddress an “open bite” dental condition. Enhancement of theocclusal-gingival extent of the casting forms 54′ causes theircorresponding casting form occlusal surface 66′ to engage theircorresponding lower first molar 18 to at least reduce the potential forfurther eruption of the same (to resist further protrusion from thegingiva 22, and possibly even to force the lower first molar 18 in thedirection of the pair of arrows presented in FIG. 7).

Another embodiment of an mandibular advancer 52 ^(iv) is presented inFIG. 8. Referring now to FIG. 8, a mandibular advancer 52 ^(ii) of thetype discussed above is installed on each side of the lower dental arch6. In this case, however, the corresponding casting forms 54 areinstalled over only two teeth, namely the lower first bicuspid 14 andthe lower second bicuspid 16. Moreover, the casting form mandibularadvancement incline 86 of each of these mandibular advancers 52 ^(ii) isdisposed to project at least generally distally, whereas in theconfiguration discussed above in relation to FIG. 1B the inclines 86projected at least generally mesially.

A pair of mandibular advancers 54 ^(iv) are installed on both sides ofthe upper dental arch 26. Each of these mandibular advancers 52 ^(iv)includes a casting form 54″ with polymerized material therein 98. A“double prime” designation is used for the casting forms 54″ on theupper dental arch 26 in the case of the mandibular advancers 52 ^(iv)since they have a reduced occlusal-gingival extent compared to thecasting forms 54 used by the mandibular advancer(s) 52 ^(ii) (the dashedline in FIG. 8 representing the casting form occlusal surface 66 of themandibular advancer 52 ^(ii)). More specifically, at least a portion ofthe casting form occlusal surface 66″ is recessed or concave to least acertain degree. The mandibular advancers 52 ^(iv) with their modifiedcasting forms 54″ generally address a “deep bite” dental condition.Reduction of the occlusal-gingival extent of the casting forms 54″allows for further eruption of their corresponding lower first molar 18(i.e., it allows the lower first molars 18 to continue to advance fromthe gingiva 22 in the direction of the pair of arrows illustrated inFIG. 8).

Another embodiment of an mandibular advancer 52, including theindividual components thereof, is illustrated in FIGS. 9-13. Themandibular advancer 52 ^(v) of FIGS. 9-13 includes a casting form 54 ofthe type discussed above in relation to the mandibular advancer 52^(ii). Polymerized material 98 of the above-described type is alsoincluded within the casting form 54 of the mandibular advancer 52 ^(v)(FIG. 13). The mandibular advancer 52 ^(v), however, also includes acrown assembly 130 which is disposed within the repository 88 of thecasting form 54. Various benefits are associated with including thecrown assembly 130 within the casting form 54, including enhancing the“robustness” of the interconnection of the mandibular advancer 52 ^(v)with the subject dental arch and enhancing the strength of the surfaceof the mandibular advancer 52 ^(v) which “cams” to affect mandibularadvancement.

The crown assembly 130 generally includes an crown 132 and a crownmandibular advancement incline frame 144 which is separately attachedthereto. The crown 132 generally includes a crown occlusal surface 136and an annular crown skirt 140 which extends away from the crownocclusal surface 136 and toward the patient's gingiva when the crown 132is disposed over a tooth in the subject dental arch. The crown occlusalsurface 136 is a flat, planar surface. Conventional crowns typicallyinclude an undulating occlusal surface to at least generally replicatethe occlusal surface of the underlying tooth. Therefore, theconfiguration of the crown 132 is itself a significant departure fromconventional crown designs. However, the crown 132 may still formed frommaterials used in conventional crowns, such as stainless steel,titanium, gold, and aluminum.

The crown mandibular advancement incline frame 144 is attached to thecrown occlusal surface 136 of the crown 132. Preferred materials for thecrown mandibular advancement incline frame 144 include metals such asstainless steel and titanium. Appropriate attachment techniques therebyinclude possibly spot welding, although brazing is presently preferred.

Components of the crown mandibular advancement incline frame 144 includea first frame section 148 and a second frame section 156. The secondframe section 156 is preferably integrally formed with the first framesection 148 (i.e., formed from the same piece of material such thatthere is no joint of any kind therebetween). An acute angle (i.e., lessthan 90 degrees) exists between the first frame section 148 and thesecond frame section 156, and in one embodiment this angle is about 70degrees. As such, the second frame section 156 is disposed at an angleof about 20 degrees relative to vertical, or the same as the angulardisposition of the casting form mandibular advancement incline 86 of thecasting form 54 as noted above. Therefore, the second frame section 156may also be characterized as the crown mandibular advancement incline156. The second frame section 156 may also actually define the “active”surface of the mandibular advancer 52 ^(v) should the material of thecasting form mandibular advancement incline 86 “wear away” duringtreatment.

Polymerized material 98 exists within the casting form 54 of themandibular advancer 52 ^(v) as will be discussed in more detail below.Certain features are incorporated in the crown assembly 130 to enhanceone or more aspects of this polymerized material 98. For instance, apair of first apertures 152 are disposed in that portion of the firstframe section 148 which overlies the crown occlusal surface 136 of thecrown 132. Polymerized material 98 preferably occupies the entire extentof these apertures 152 to improve the “interlock” between the crownassembly 132 and casting form 54 of the mandibular advancer 52 ^(v).Another pair of apertures 160 are included in that portion of the firstframe section 148 which extends beyond the “oval” of the crown 132(i.e., beyond the crown skirt 140) and which are illustrated in FIG. 12.These particular apertures 160 facilitate the inclusion of polymerizedmaterial 98 between the crown skirt 140 and the first end 58 of thecasting form 54 as illustrated in FIG. 13. Polymerized material 98 alsosupports the second frame section 156 in the noted angular positionrelative to the first frame section 148. In this regard, polymerizedmaterial 98 preferably occupies the entire extent of a pocket 168 whichis defined by the first frame section 148, the second frame section 156,and a pair of extensions 164 which project from the first frame sectiontoward, but not to, the apex of the second frame section 156. This“apex” of the second frame section 156 includes a rounded section byincluding a curl on the free end of the second frame section 156.

The mandibular advancer 52 ^(v) of FIGS. 9-13 is installed on thepatient generally in the same manner discussed above with regard to themandibular advancer 52 ^(ii) of FIGS. 1B and 4. There are of course somevariations due to the inclusion of the crown assembly 130. Consider thecase where a stone casting is made of the upper dental arch 26 forpurposes of assembling the mandibular advancer 52 ^(v). Here the crown132 is disposed over a single tooth within the upper dental arch 26(e.g., the upper second bicuspid 36) and properly fitted to thecorresponding gingiva (e.g., via a trimming of the crown skirt 140 in amanner known in the art) before the casting form 54 with the flowablematerial therein is disposed over the upper dental arch 26 in generallythe above-described manner. Moreover, the crown mandibular advancementincline frame 144 is placed into the desired position on the crownocclusal surface 136 before the casting form 54 with the flowablematerial therein is disposed over the upper dental arch 26 in generallythe above-described manner. Typically this position will then be markedon the crown occlusal surface 136 such that the attachment of the crownmandibular advancement incline frame 144 to the crown 132 may beaffected while of f of the stone casting of the upper dental arch 26.However, it may be possible to attach the crown mandibular advancementframe incline frame 144 to the crown 132 while still on the stonecasting. In any case, the crown 132 is removed from the stone casting ofthe upper dental arch 26 so that the release agent may be disposed onappropriate portions of the upper dental arch 26 in the above-notedmanner and for the above-noted purposes. In this regard and with thecrown mandibular advancement incline frame 144 then being appropriatelyfixed to the crown 132 in the desired position, the crown 132 isdisposed over the desired tooth within the upper dental arch 26 (e.g.,the upper second bicuspid 36). Then the casting form 54 with theflowable material therein is disposed over the crown assembly 130, aswell as at least one other tooth of the upper dental arch 26. Again,typically the casting form 54 will be disposed over the entirety of atleast two teeth in a given dental arch, and at least part of a thirdtooth (e.g., the second molar). In the illustrated embodiment, thecasting form 54 of the mandibular advancer 52 ^(v) will be disposed overthe entirety of the upper second bicuspid 36 (although the crownassembly 130 is of course disposed therebetween), the upper first molar38, and part of the upper second molar 40. Completion of theinstallation of the mandibular advancer 52 ^(v) thereafter proceeds atleast generally in accordance with the protocol set forth above for themandibular advancer 5211.

Another embodiment of an mandibular advancer is presented in FIG. 14,and which is fundamentally the same as the mandibular advancer 52 ^(v)of FIGS. 9-13 discussed above. Similar components are thereby similarlynumbered, but a “single prime” designation is used in relation to thecrown assembly 130 and a “triple prime” designation is used in relationto the casting form 54. The mandibular advancer 52 ^(vi) generallyutilizes a crown mandibular advancement incline frame 144′ having alonger first frame section 148′ so as to dispose the second framesection 156′ further from the tooth-long axis of the tooth over whichthe crown 132′ is disposed. Note that one of the apertures 152 ^(i) isnow disposed beyond the crown skirt 140′. Another difference is that thecasting form lingual skirt 82′″ and the casting form buccal skirt 78′″(not shown) have a larger occlusal-gingival extent than in the case ofthe casting form 54. Otherwise, the casting form mandibular advancer 54^(vi) is substantially the same as the mandibular advancer 52 ^(v).

Another embodiment of an mandibular advancer 52 is presented in FIG. 15.The mandibular advancer 52 ^(vii) of FIG. 15 includes a crown 204 whichhas a crown occlusal surface 208 and a crown skirt 212 which extendsfrom the crown occlusal surface 208 and toward the patient's gingivawhen the crown 204 is disposed over a particular tooth in the subjectdental arch. The profile of the crown occlusal surface 208 may becontoured in the manner of conventional crowns, or may be flat asdescribed above in relation to the crown 132 used by the mandibularadvancer 52 ^(v) of FIGS. 9-13.

The crown 204 further includes an extension 216 which projects away fromthe crown skirt 212 along a direction which is at least generallyparallel with the mesio-distal direction when the crown 204 is installedover a tooth. Preferably the crown occlusal surface 208, the crown skirt212, and the extension 216 are integrally formed (i.e., formed from asingle piece of material such that there is no joint of any kindtherebetween). The extension 216 includes a skirt end 220 and a free end224 on which is disposed a crown mandibular advancement incline 228which defines the active surface of the mandibular advancer 52 ^(vii).As such, the crown mandibular advancement incline 228 is disposed beyondthe “oval” of the crown 204 (i.e., beyond the crown skirt 212).

Various techniques may be used to integrally form the extension with thecrown skirt 212 and/or crown occlusal surface 208, includinghydroforming or explosive forming techniques which produce a hollowextension 216. In this case, any number of standard chemicallypolymerizing dental and orthodontic adhesive systems may be used tofixedly mount the crown 204 over/onto the desired tooth. These types ofmaterials are sufficiently rigid when cured to enhance the support ofthe crown mandibular advancement incline 228. That is, an amount oforthodontic bonding system material may be positioned within the crown204 before installing the same over the tooth such that the entirety ofthe hollow interior of the extension 216 is occupied by this orthodonticbonding system material when the crown 204 is installed over the subjecttooth. Alternatively, the hollow interior of the extension 216 mayremain “unoccupied” when the crown 214 is mounted on the subject tooth.

Another technique which may be used to form the crown 204 in an integralfashion would entail having a mold in the shape of the crown 204, andwhich included a spacer or the like disposed within the mold. When thisspacer was removed, the remaining space would define the hollow interiorfor the crown skirt 212. In this case the extension 216 would be solidand integrally formed with a solid upper portion of the crown 204 (e.g.,the “upper” portion of the crown 204 which includes the crown occlusalsurface 208), as well as the crown skirt 212. Vacuum-forming techniquescould also be employed to define an integral plastic crown 204 with ahollow extension 216. Those materials noted above relating to the crown102 may be used for the crown 204 in this instance.

The configuration of the crown 204 could be realized by a non-integralconstruction as well (i.e., such that there was at least one joint inthe structure of the crown 204). For instance, the above-noted spacercould be replaced with a body having an occlusal surface and an annularskirt. In this case, the upper portion of the materials that were beingmolded would not only define the extension 216 in a solid form, butwould also extend over the occlusal surface of this crown body andinterconnect with the same. At least a portion of the crown skirt 212would then be defined by this hollow body.

In the configuration illustrated in FIG. 15, the mandibular advancer 52^(vii) includes only the crown 204 with its various features. Avariation would be to use the crown 204 in combination with the castingform 54 discussed above in relation to the mandibular advancer 52 ^(ii),and in the generally same manner as will be discussed above in relationto the mandibular advancer 52 ^(v) of FIGS. 9-13. Generally, the crown204 would be installed over a tooth in the subject dental arch in theabove-described manner, and the casting form 54 would be disposed overthe crown 204 and at least one additional tooth in the subject dentalarch so as to dispose the casting form mandibular advancement incline 86and crown mandibular advancement incline 228 at least generallyproximate to each other and at least in generally parallel relation, andmore preferably in interfacing relation. The flowable material would becured with the crown 204 being within the casting form 54 toappropriately interconnect the same.

Another embodiment of an mandibular advancer 52 is presented in FIG. 16.The mandibular advancer 52 ^(viii) of FIG. 16 includes a crown 176. Thecrown 176 has a crown occlusal surface 180 and the crown skirt 196 whichextends from the crown occlusal surface 180 and toward the patient'sgingiva when the crown 176 is disposed over a particular tooth in agiven dental arch. The crown occlusal surface 180 includes a firstocclusal section 184 and a second occlusal section 188 which aredisposed at different elevations. As such, when the crown 176 isdisposed over a given tooth within a particular dental arch, the secondocclusal section 188 is disposed further from the occlusal planeassociated with this particular dental arch than the first occlusalsection 184. Both the first occlusal section 184 and the second occlusalsection 188 are at least generally flat, planar surfaces, and in oneembodiment are disposed at least substantially parallel with theocclusal plane of the dental arch on which the crown 176 is installedover one of its corresponding teeth.

A crown mandibular advancement incline 192 extends between andinterconnects the first occlusal section 184 and the second occlusalsection 188 of the crown 176, and defines the “active” surface of themandibular advancer 52 ^(viii). As such, the crown mandibularadvancement incline 192 is also part of the crown occlusal surface 180and is disposed at somewhat of a “mid” portion thereof (e.g., it isdisposed closer to a central axis which corresponds with a tooth-longaxis of a tooth over which the crown 176 is disposed, than to the crownskirt 196). The materials noted above in relation to the crown 102 maybe used for the crown 176 as well.

Another embodiment of an mandibular advancer 52 is presented in FIGS.17A-B and 18. The mandibular advancer 52 ^(ix) of FIGS. 17A-B and 18includes a band assembly 234. The band assembly 234 in turn includes aband 236 which is defined by an annular skirt 238 which may be disposedcircumferentially about a particular tooth within the desired dentalarch. A band mandibular advancement frame 240 is attached to this band236 on generally the buccal and lingual sides thereof (e.g., spotwelding, brazing). Disposed on the free end of the band mandibularadvancement frame 240 is a band mandibular advancement incline 244 andwhich defines the “active” surface for the mandibular advancer 52 ^(ix).

In the configuration illustrated in FIGS. 17A-B and 18, the mandibularadvancer 52 ^(ix) includes only the band assembly 234 with its variousfeatures. A variation would be to use the band assembly 234 incombination with the casting form 54 discussed above in relation to themandibular advancer 52 ^(ii), and in the generally same manner asdiscussed above in relation to the mandibular advancer 52 ^(v) of FIGS.9-13. Generally, the band assembly 234 would be installed around a toothin the subject dental arch in the above-described manner, and thecasting form 54 would be disposed over the band assembly 234 and atleast one additional tooth in the subject dental arch so as to disposethe casting form mandibular advancement incline 86 and band mandibularadvancement incline 244 at least generally proximate to each other andat least in generally parallel relation, and more preferably ininterfacing relation. The flowable material would be cured with the bandassembly 234 being within the casting form 54 to appropriatelyinterconnect the same.

Another embodiment of a mandibular advancer 52 which may be used by themandibular advancement system 50 is presented in FIGS. 19 and 20A-B. Themandibular advancer 52 ^(x) of FIGS. 19 and 20A-B includes a crown 252which is installed over a tooth in the subject dental arch. Typicallythe mandibular advancer 52 ^(x) will be incorporated into a mandibularadvancement system 50 by being installed on both sides of both the upperdental arch 24 and the lower dental arch 6 (FIGS. 1A-B), typically onboth of the upper first molars 38 and on both of the lower first molars18. The crown 252 generally includes a crown occlusal surface 256 and anannular crown skirt 264 which extends away from the crown occlusalsurface 256 and toward the corresponding gingiva when the crown 252 isinstalled over a tooth within a given dental arch.

A crown mandibular advancement incline 260 defines at leastsubstantially the entirety of, and more preferably the entirety of, thecrown occlusal surface 256 of the crown 252, and is the “active” surfaceof the mandibular advancer 52 ^(x). Generally the crown mandibularadvancement incline 260 occupies/extends along the entire mesio-distalextent of the crown 252. Like the other mandibular advancement inclinesdescribed herein, the crown mandibular advancement incline 260 ispreferably an at least substantially flat, planar surface. However, theorientation of the crown mandibular advancement incline 260 relative tothe corresponding occlusal plane differs from the orientation of theother mandibular advancement inclines addressed herein. The crownmandibular advancement incline 260 assumes an orientation which is moreflat than the mandibular advancement inclines discussed above. In oneembodiment, the crown mandibular advancement incline 260 is disposed atan angle of no more than about 20° relative to horizontal or to a planewhich is parallel with the occlusal of the subject dental arch (e.g.,more than about 70° relative to vertical), and is more preferablydisposed at an angle of about 16° relative to horizontal or a planewhich is parallel with the occlusal of the subject dental arch. Thisorientation of the crown mandibular advancement incline 260 provides theadvantage of providing positive forward/rearward guidance to themandible 4 of a patient, while the increased length (measuredmesio-distally) of the incline 260 significantly reduces the potentialfor becoming disengaged with the active surface of the mandibularadvancer 52 disposed on the opposite dental arch. That is, the patientshould not be able to move his/her mandible 4 to a position where thecrown mandibular advancement inclines 260 on the patient's upper dentalarch 260 will become disengaged with the corresponding crown mandibularadvancement inclines 260 on the patient's lower dental arch 6.

With the crown mandibular advancement incline 260 being on and in factdefining at least substantially the entirety of the crown occlusalsurface 256, the crown 252 is “taller” than conventional crowns. Whenthe crown 252 is installed over the desired tooth, there is a spacebetween the occlusal surface of this tooth and the crown occlusalsurface 256. In one embodiment, the minimum vertical extent of thisspace is about 2 mm at the apex of the crown mandibular advancementincline 260, and may be as much as about 3.5 mm at the apex of the crownmandibular advancement incline 260 (measured relative to theocclusal-most surface of the corresponding tooth). A suitableorthodontic bonding system may be used to fixedly mount the crown 252over/onto the subject tooth. These types of materials are sufficientlyrigid when cured to enhance the support of the crown mandibularadvancement incline 260. That is, an amount of orthodontic bondingsystem material may be positioned within the crown 252 before installingthe same over the subject tooth such that the entirety of the spacebetween the crown 252 and the corresponding tooth is occupied by thisorthodontic bonding system material when the crown 252 is installed overthe subject tooth. Alternatively, the space may remain as an “air gap”between the crown occlusal surface 256 and the occlusal surface of thetooth on which the crown 252 is mounted.

The existence of the above-noted space facilitates the dispositioning ofthe crown mandibular advancement incline 260 in a desired position wheninstalled over its corresponding tooth (e.g., disposed at an angle of nomore than about 20 degrees relative to a plane which is parallel withthe occlusal of the dental arch having the tooth over which the crown252 is installed). In this regard, the gingival-most extreme of thecrown mandibular advancement incline 260 initiates where the tip of thecorresponding tooth begins to extend inwardly toward its tooth-long axisand is disposed in at least generally parallel relation therewith. Theincline 260 continues to extend occlusally beyond the occlusal surfaceof this tooth. In one embodiment, the length of the crown mandibularadvancement incline 260 is within a range of about 8 mm to about 12 mm(measured parallel to the incline 260), the width of the crownmandibular advancement incline 260 is within a range of about 5 mm toabout 9 mm, and/or has an area within a range of about 40 mm² to about108 mm². Therefore, the surface area of the crown mandibular advancementincline 260 is larger than the surface area of other inclines addressedherein. This larger surface area of the crown mandibular advancementincline 260 again provides the advantage of reducing the potential, andin all likelihood eliminating, the potential that the inclines 260disposed on the upper dental arch 26 of the patient will becomedisengaged with their corresponding incline 260 disposed on the lowerdental arch 6 of the patient.

The crown occlusal surface 256, the crown mandibular advancement incline260, and the crown skirt 264 are integrally formed, similar to the crown102 of FIGS. 5-6. Stated another way, the crown occlusal surface 256,the crown mandibular advancement incline 260, and crown skirt 264 areformed from a single piece of material such that there is no joint ofany kind between any of these components. Materials which are commonlyused to make conventional crowns may be used to make the crowns 252 hereas well, such as stainless steel, titanium, gold, and aluminum. Othermaterials such as vacuum-formed plastics such as polycarbonate, acrylic,styrene, buturate, and vinyls may be used as well for the crowns 252.

There are a number of benefits associated with the crown 252. One is itsrelative simplicity of manufacture since it is integrally formed and dueto the configuration/orientation of the crown mandibular advancementincline 260. Another is that its crown mandibular advancement incline260 facilitates the use of the crown 252 on the patient's first molars(both upper and lower as noted above). FIGS. 20A-B each show anorientation to affect mesial advancement of the patient's mandible, withthe arrow 268 being pointed in the mesial direction. The first molarsprovide a strong and sturdy anchorage for the types of forcesencountered when affecting the type of mandibular advancement treatmentaddressed herein. Moreover, the first molars come into the mouth whenthe patient is about 6 years of age, so the mandibular advancers 52 ^(x)may be used on very young patients. Finally, using the crowns 252 in amandibular advancement system 50 alleviates the need for a mandibularadvancement incline which is “mesially extended” for the two mandibularadvancers 52 used on the patient's upper dental arch 26.

The crown 252 with its various features may define the entirety of themandibular advancer 52 ^(x) as described above. A variation would be touse the crown 252 in combination with the casting form 54 discussedabove in relation to the mandibular advancer 52 ^(ii), and in thegenerally same manner as discussed above in relation to the mandibularadvancer 52 ^(v) of FIGS. 9-13. Generally, the crown 252 would beinstalled over a tooth in the subject dental arch in the above-describedmanner, and the casting form 54 would be disposed over the crown 252 andat least one additional tooth in the subject dental arch so as todispose the casting form mandibular advancement incline 86 and crownmandibular advancement incline 260 at least generally proximate to eachother and at least in generally parallel relation, and more preferablyactually in interfacing relation. The flowable material would be curedwith the crown 252 being within the casting form 54 to appropriatelyinterconnect the same.

Another embodiment of an mandibular advancer 52 which may be used by themandibular advancement system 50 is presented in FIGS. 21-22. Themandibular advancer 52 ^(xi) of FIGS. 21-22 includes a crown 280 whichis installed over a tooth in the subject dental arch. The crown 280generally includes a crown occlusal surface 284 and an annular crownskirt 296 which extends away from the crown occlusal surface 284 andtoward the corresponding gingiva when the crown 280 is installed over atooth within a given dental arch. The shape of the crown occlusalsurface 284 should not significantly affect the generation of mandibulartreatment forces by the crown 280. Therefore, any shape/configurationmay be utilized for the crown occlusal surface 284, including being atleast substantially flat or planar as shown, and preferably at leastgenerally in parallel relation with the occlusal of the correspondingdental arch, as well as being contoured to least generally approximatethe occlusal anatomy of the tooth on which the crown 280 is installed(not shown).

A crown mandibular advancement incline 292 is disposed on an “end” 288of the crown 280 which will be either mesially or distally disposed whenthe crown 280 is installed on a tooth in the subject dental arch andfurther depending upon the desired directional movement of the mandible4. The crown mandibular advancement incline 292 would be disposed on thedistal if the crown 280 is installed on a tooth in the lower dental arch6 (i.e., be distally disposed) to affect mandibular advancement, andwould be disposed on the mesial if the crown 280 is installed on a toothin an upper dental arch 26 (i.e., be mesially disposed) to affectmandibular advancement. The “active” surface of the mandibular advancer52 ^(xi) is the crown mandibular advancement incline 292, and in oneembodiment this incline 292 curves at least generally about a referenceaxis 298 which is a least generally parallel with a tooth-long axis ofthe tooth on which the crown 280 is installed. This is one distinctionbetween the orthodontic mandibular advancer 52 ^(xi) of FIGS. 21-22 andthe orthodontic mandibular advancer 52 ^(i) of FIGS. 5-6 as describedabove where it's crown mandibular advancement incline 112 wascharacterized as being an at least substantially flat, planar surface.

As in at least some of the above-noted cases where crowns have beendescribed for use in relation to movement of the mandible 4, the crown280 may be used alone to function as a mandibular advancer 52, or may bedisposed withing a casting form 54 to define an assembly for amandibular advancer 52.

Another embodiment of an mandibular advancer 52 is presented in FIGS.23-24. The mandibular advancer 52 ^(xii) of FIGS. 23-24 includes a crown300. The crown 300 has a crown occlusal surface 304 and a crown skirt320 which extends from the crown occlusal surface 304 and toward thepatient's gingiva when the crown 300 is disposed over a particular toothin a given dental arch. The crown occlusal surface 304 includes a firstocclusal section 308 and a second occlusal section 312 which aredisposed at different elevations or in vertically-spaced relation. Assuch, when the crown 300 is disposed over a given tooth within aparticular dental arch, the second occlusal section 312 is disposedfurther from the occlusal plane associated with this particular dentalarch than the first occlusal section 308. The shape of the firstocclusal section 308 and the shape of the second occlusal section 312should not affect the generation of mandibular movement treatment forcesby the crown 300. Therefore, any shape/configuration may be utilized forboth the first and second occlusal sections 308, 312, including being atleast substantially flat or planar, and preferably in at least generallyparallel relation with the occlusal of the corresponding dental arch, aswell as being contoured to at least generally approximate the occlusalanatomy of the tooth on which the crown 300 is mounted (not shown). Inthose cases where the crown mandibular advancement incline 316 of thecrown 300 is disposed on the extreme mesial or distal end of the crown300 as shown in FIGS. 23-24, the second occlusal section 312 will be ofsuch a reduced mesio-distal extent that the same will typically be atleast generally convexly-shaped (e.g., in effect defined by a radius),and will likely be of insufficient mesio-distal extent to approximateany occlusal anatomy of a tooth.

The crown mandibular advancement incline 316 of the crown 300 of FIGS.23-24 extends between and interconnects the first occlusal section 308and the second occlusal section 312 of the crown 300, and defines the“active” surface of the mandibular advancer 52 ^(xii) in relation to thegeneration of forces for affecting movement of the mandible 4. As such,the crown mandibular advancement incline 316 is also part of the crownocclusal surface 304 and is disposed at an intermediate portion thereof(e.g., somewhere between the mesial and distal extremes of the crown 300when installed on a particular tooth). Therefore and in at least thisrespect, the crown 300 of FIGS. 23-24 is at least generally similar tothe crown 176 described above in relation to FIG. 16. There are,however, differences between these two embodiments. One is that thecrown mandibular advancement incline 316 of the crown 300 of FIGS. 23-24curves at least generally about a reference axis 324 which is a leastgenerally parallel with a tooth-long axis of the tooth on which thecrown 300 is installed, whereas the crown mandibular advancement incline196 of the crown 176 was noted above to be at least substantially flator planar. Another distinction is the location of the crown mandibularadvancement incline 316. In the case of the crown 300, its crownmandibular advancement incline 316 is disposed closer to its mesial ordistal extreme of the crown 300 than the crown mandibular advancementincline 192 of the crown 176 of FIG. 16. Generally, the crown 300 in theform illustrated in FIGS. 23-24 will typically be utilized for a rathersignificant Class II malocclusion where the patient's mandible 4 israther significantly retracted. In this case, the crown 300 willtypically be mounted on a lower first molar 18 and with the incline 316being disposed at least generally proximate the mesial end of the crown300. Stated another way, the crown mandibular advancement incline 316will project at least generally distally.

For those cases where a mandibular advancement crown includes a crownmandibular advancement incline on its crown occlusal surface (e.g.,crown 176 of FIG. 16, crown 300 of FIGS. 23-24), this crown mandibularadvancement incline may actually be disposed at any mesial-distallocation or position on its corresponding crown occlusal surface. Itshould be appreciated that there will be some limit as to how close sucha crown mandibular advancement incline may be disposed to the mesial ordistal extreme of the crown. Generally and in relation to the crown 300of FIGS. 23-24, the minimum mesio-distal extent of the second occlusalsection 312 will be approximately twice the wall thickness of thematerial which has been used to form the crown 300.

FIG. 25 illustrates a crown 330. The crown 330 has what may becharacterized as a conventional crown occlusal surface 334 (i.e.,contoured to least generally approximate the occlusal anatomy of thetooth on which the crown 330 is mounted or installed), and a crown skirt338 which extends from the crown occlusal surface 334 and toward thepatient's gingiva when the crown 330 is disposed over a particular toothin a given dental arch. There are at least two applications contemplatedfor the crown 330. Both of these applications entail mounting the crown330 on a tooth in a given dental arch such that it has a “higher”profile than conventional crowns (e.g., mounted more “proudly” on thesubject tooth). That is, the crown 330 is installed on the desired toothsuch that a space exists between the occlusal surface of the tooth andthe interior of the crown occlusal surface 334 of the crown 330 as willbe discussed in more detail below. The shape of the crown occlusalsurface 334 should not significantly affect the functionality of thecrown 330 for either of the applications currently contemplated for thecrown 330 and which will be addressed below. Therefore, anyshape/configuration may be utilized for the crown occlusal surface 334,including being at least substantially flat or planar, and preferably inat least generally parallel relation with the occlusal of thecorresponding dental arch (not shown), as well as being contoured to atleast generally approximate the occlusal anatomy of the tooth on whichthe crown 300 is mounted and as illustrated in FIG. 25.

One application for the crown 330 is as a mandibular advancer 52.Activating forces for affecting movement of the mandible 4 in this caseare realized through a transition 342 which is disposed between thecrown occlusal surface 334 and the annular crown skirt 338, and whichthereby functions as a crown mandibular advancement incline inaccordance with the foregoing. This transition 342 has a generallyarcuate and somewhat of a convex shape. Another application for thecrown 330 is for providing additional occlusal support during movementof the patient's mandible 4. More specifically, the crowns noted abovewhich have at least some type of “active” surface foraffecting/retaining mandibular movement/position may be “taller” thanconventional crowns (i.e., such that there is a space between theocclusal surface of the tooth and the interior of the crown occlusalsurface). As such, the patient's jaw is retained in a somewhat more“open” position when these active surfaces are engaging or are fullingengaged. Installing at least one or more crowns 330 on each side of thepatient's upper dental arch 26 and/or lower dental arch 6 may beutilized to provide additional occlusal support for the patient in theseinstances, provided these crowns 330 also have an enhancedgingival-occlusal extent and/or such that there is a space between theocclusal surface of the tooth and the interior of the crown occlusalsurface 334.

FIGS. 26 and 27 illustrate two examples of the “occlusal support”application/function for the crown 330 of FIG. 25. Typically it isdesirable to have approximately ½ of the mesial-distal extent of thelower first molars 18 be actually oclussally-gingivally aligned withtheir corresponding upper second bicuspid 36 at the end of treatment.Both FIGS. 26 and 27 thereby illustrate the mandible 4 being in somewhatof a retracted position. FIG. 26 illustrates a situation where thepatient's mandible 4 is disposed such that the upper first molars 38 arealigned with the lower first molars 18 (possibly at an intermediate timeof treatment), whereas FIG. 27 illustrates a situation where thepatient's mandible 4 is even in a more retracted state (possibly at thestart of treatment). Both FIGS. 26 and 27 illustrate only one side ofthe patient's upper dental arch 26 and the patient's lower dental arch6. It should be appreciated that the opposite side of each of thesearches 26, 6 would be similarly configured with the devices which willnow be described.

Mandibular advancement is affected in the FIG. 26 configuration byinstalling a crown 280 on the upper first molar 38a such that its crownmandibular advancement incline 292 is mesially disposed. Note theexistence of the gap between the interior surface of the crown occlusalsurface 284 and the occlusal surface of the upper first molar 38 a. Acrown 300 is installed on the lower first molar 18 a such that its crownmandibular advancement incline 316 is at least generally mesiallydisposed. Note the existence of the gap between the interior surface ofthe first occlusal section 308 and the occlusal surface of the lowerfirst molar 18 a. Engagement of the opposing crown mandibularadvancement inclines 292, 316 affects mandibular advancement at leastgenerally in the above-described manner. In any case, a rathersignificant gap exists between the patient's upper dental arch 26 andlower dental arch 6 in the FIG. 26 configuration. Enhanced occlusalsupport for the patient in this condition is provided by installing onecrown 330 of an enhanced occlusal-gingival extent on at least one of,and more preferably each of, the lower second bicuspid 16 a (the “E” inthe case of a younger patient) and the lower first bicuspid 14 a (the“D” in the case of a younger patient) to provide a space between theocclusal surfaces of these teeth and the interior of the correspondingcrown occlusal surface. These crowns 330 engage the upper secondbicuspid 36 a (the “E” in the case of a younger patient) and the upperfirst bicuspid 34 a (the “D” in the case of a younger patient),typically when the crown occlusal surface 284 of the crown 280 engagesthe first occlusal section 308 of the crown 300. Similar benefits couldbe realized by installing one or more of such crowns 330 on anappropriate tooth of the upper dental arch 26 for interfacing with anopposing tooth on the lower dental arch 6.

Mandibular advancement is affected in the FIG. 27 configuration byinstalling a crown 280 on the upper first molar 38 a such that its crownmandibular advancement incline 292 is mesially disposed. Note theexistence of the gap between the interior of the crown occlusal surface284 and the occlusal surface of the upper first molar 38 a. Anothercrown 280 is installed on the lower second bicuspid 16 a (the “E” in thecase of a younger patient) such that its crown mandibular advancementincline 292 is distally disposed. Note the existence of the gap betweenthe interior of the crown occlusal surface 284 and the occlusal surfaceof the lower second bicuspid 16 a. Engagement of the opposing crownmandibular advancement inclines 292 affects mandibular advancement atleast generally in the above-described manner. In any case, a rathersignificant gap exists between the patient's upper dental arch 26 andlower dental arch 6 in the FIG. 27 configuration. Enhanced occlusalsupport for the patient in this condition is provided by installing onecrown 330 of an enhanced occlusal-gingival extent on the lower firstbicuspid 14 a to provide a space between the occlusal surface of thelower first bicuspid 14 a and the interior of the crown occlusal surface334. This crown 330 will engage the upper first bicuspid 34 a, typicallyafter/when the crown occlusal surfaces 284 of the opposing crowns 280become engaged. Similar benefits again could be realized by installingone or more of such crowns 330 on an appropriate tooth of the upperdental arch 26 for interfacing with an opposing tooth on the lowerdental arch 6.

Various types of mandibular advancers 52 have been described herein. Anumber of specific configurations of sorts for affecting mandibulartreatment/therapy will now be addressed. In one embodiment, a crown 330is mounted on each of the patient's upper first molars 38 such that agap exists between the occlusal surface of the upper first molar 38 andthe interior surface of the corresponding crown occlusal surface 334. Acrown 330 is also mounted on each of the patient's lower secondbicuspids 16 (the “E” in the case of a younger patient) such that a gapalso exists between the occlusal surface of the lower second bicuspid 16and the interior surface of the corresponding crown occlusal surface334. Activation forces for affecting mandibular advancement are realizedby engaging the transition region 342 on the mesial end of each of thecrowns 330 mounted on the upper first molars 38 with the transitionregion 342 on the distal end of their corresponding crown 330 mounted onthe lower second bicuspid 16.

Another configuration which may be utilized for mandibular advancementinvolves installing a crown 330 on each of the patient's upper firstmolars 38 such that a gap exists between the occlusal surface of theupper first molar 38 and the interior surface of the corresponding crownocclusal surface 334. A crown 300 is mounted on each of the patient'slower first molars 18 such that a gap exists between the occlusalsurface of the lower first molars 18 and the interior surface of thecorresponding crown occlusal surface 334, and further such that eachsecond occlusal section 312 is mesially disposed. This configurationwill typically be utilized for cases when the patient's mandible 4 issignificantly retracted. In any case, activation forces for affectingmandibular advancement are realized by engaging the transition region342 on the mesial end of each of the crowns 330 mounted on the upperfirst molars 38 with the crown mandibular advancement incline 316 oftheir corresponding crown 300 mounted on the lower first molar 18.

Another configuration which may be utilized for mandibular advancementinvolves installing a crown 280 on each of the patient's upper firstmolars 38 such a gap exists between the occlusal surface of the upperfirst molar 38 and the interior surface of the corresponding crownocclusal surface 284, and further such that the crown mandibularadvancement incline 292 is mesially disposed. A crown 280 is mounted oneach of the lower second bicuspids 16 (the “E” in the case of a youngerpatient) such that a gap exists between the occlusal surface of thelower second bicuspid 16 and the interior surface of the correspondingcrown occlusal surface 284, and further such that the crown mandibularadvancement incline 292 is distally disposed. Activation forces foraffecting mandibular advancement are realized by engaging the crownmandibular advancement incline 292 of the crowns 280 mounted on theupper first molars 38 with the crown mandibular advancement incline 292of their corresponding crown 280 mounted on the lower second bicuspid16.

Another configuration which may be utilized for mandibular advancementinvolves installing a crown 280 on each of the patient's upper firstmolars 38 such that a gap exists between the occlusal surface of theupper first molar 38 and the interior surface of the corresponding crownocclusal surface 284, and further such that the crown mandibularadvancement incline 292 is mesially disposed. A crown 300 is mounted oneach of the patient's lower first molars 18 such that a gap existsbetween the occlusal surface of the lower first molar 18 and theinterior surface of the corresponding crown occlusal surface 304, andfurther such that the second occlusal section 312 is mesially disposed.Activation forces for affecting mandibular advancement are realized byengaging the crown mandibular advancement incline 292 of the crowns 280mounted on the upper first molars 38 with the crown mandibularadvancement incline 316 of their corresponding crown 300 mounted on thelower first molar 18.

Another configuration which may be utilized for mandibular advancementinvolves installing a crown 280 on each of the patient's upper firstmolars 38 such that a gap exists between the occlusal surface of theupper first molar 38 and the interior surface of the corresponding crownocclusal surface 284, and further such that the crown mandibularadvancement incline 292 is mesially disposed. A crown 330 is mounted oneach of the patient's lower second bicuspids 16 (the “E” in the case ofa younger patient) such that a gap also exists between the occlusalsurface of the lower second bicuspid 16 and the interior surface of thecorresponding crown occlusal surface 334. Activation forces foraffecting mandibular advancement are realized by engaging the crownmandibular advancement incline 292 on the mesial end of each of thecrowns 280 mounted on the upper first molars 38 with the transitionregion 342 on the distal end of their corresponding crown 330 mounted onthe lower second bicuspid 16.

The crown 280 of FIGS. 21-22, the crown 300 of FIGS. 23-24, and thecrown 330 of FIG. 25 have a number of features in common. Initially,these crowns 280, 300, and 330 are each seated on the subject tooth suchthat the crowns 280, 300, 330 cover at least substantially an entiretyof the exposed enamel of the subject tooth (as will typically be thecase for the crowns 102, 204, 176, and 252 as well). Typically, thegingival edge of the crowns 280, 300, 330 will at least extend to thegingiva of the patient, and will more typically actually extend about 1mm to about 1.5 mm below or under the patient's gingiva. Another commonfeature is that each of these crowns 280, 300, and 330 are “taller” thanconventional crowns or sit more “proudly” on a tooth when installedthereon in the above-noted manner. Stated another way, the crowns 280,300, and 330 have an enhanced occlusal-gingival extent in comparison toconventional crowns. When each of these crowns 280,300, and 330 areinstalled over the desired tooth in the desired dental arch, theenhanced occlusal-gingival extent provides a space between the occlusalsurface of this underlying tooth and the interior of the relevant crownocclusal surface 284,304,334. In one embodiment, the minimum verticalextent of this space is at least about 1.5 mm and is measured along anaxis which is parallel with the tooth-long axis (which coincides withthe axis about which the crown skirt 296, 320, 338 is formed). What ismeant by the term “minimum vertical extent” is that the noted minimumvertical space exists between each point on the occlusal surface of thetooth and that portion of the relevant crown occlusal surface 284, 304,334 which is disposed therebeyond along a reference axis which isparallel to the tooth-long axis of the subject tooth.

Another way of describing the above-noted space is to assume that youcould move the crowns 280, 300, 330 gingivally (and parallel to thetooth-long axis) until it contacted an occlusal surface of itsunderlying tooth (the patient's gingiva obviously would not allow thismuch gingival travel). The noted space could then be defined by movingthe crowns 280,300,330 occlusally (again parallel with the tooth-longaxis) a distance of about 1.5 to about 2.0 mm, at which time thegingival extreme of the crowns 280, 300, 300 would be either disposed atthe gingiva of the patient or this gingival extreme would be extending“below” or “under” the gingiva by the above-noted amount.

Those materials and manufacturing techniques described above in relationto the crown 102 of FIGS. 5-6 may be implemented for the crowns 280,300, and 330. Moreover, those techniques which were discussed above withregarding to “fixing” or “attaching” any of the crowns 102, 140, 204,176, 252 may be utilized for the crowns 280, 300, and 330 as well. Inthose cases where the crowns described herein are disposed in spacedrelation to the occlusal surface of the underlying tooth, it may beadvantages to have a rigid spacer occupy at least a portion of thisspace (e.g., by being embedded within the orthodontic bonding systemmaterial).

Another embodiment of a mandibular advancer 52 is illustrated in FIGS.28-31. The mandibular advancer 52 ^(xiii) includes a cap 352 which isdisposed over the occlusal of an appropriate tooth and a band 380 whichencircles this tooth. The 352 generally includes a cap occlusal surface356 and a cap skirt 360. In the illustrated embodiment, the cap occlusalsurface 356 is at least substantially flat or planar, and is preferablydisposed at least generally parallel with the occlusal of the dentalarch on which the 352 is installed. Alternatively, the cap occlusalsurface 356 could be anatomically-shaped to at least generallyapproximate the occlusal surface of the tooth on which the cap 352 isinstalled (not shown). Unlike at least some of the embodiments discussedabove which utilized crowns as mandibular advancers 52, theocclusal-gingival extent of the cap 352 is less than theocclusal-gingival extent of the tooth on which the same is mounted.Therefore, the gingival extreme 364 of the cap skirt 360 isocclusally-gingivally spaced from the patient's gingiva.

A pair of wires 368 are fixedly attached to the cap 352 on the buccaland lingual sides of the cap 352. These wires 368 each include a firstsection 372 which is at least generally occlusally-gingivally disposed,as well as a second section 376 which is at least generallymesial-distally disposed. A buccal tube 384 is fixedly attached to theband 380 on the buccal side thereof, while a catch 388 is fixedlyattached to the band 380 on the lingual side thereof. A ligating tube392 is also fixedly attached to the band 380 on the lingual sidethereof. The ligating tube 392 is disposed gingivally of the catch 388.The second section 376 of one of the wires 368 is disposed within thebuccal tube 384, while the second section 376 of the other wire 368 isdisposed on the gingival side of the catch 388. The wire 368 which isdisposed under the catch 388 may be ligated to the band 380 via theligating tube 392.

The band 380 is conventionally attached to tooth. The cap 352 may thenbe filled with a polymerizing material that is bonded to the interior ofthe cap 352 and disposed over the tooth and an annular occlusal portionof the band 380 (i.e., the cap 352 does not completely cover the band380). At least at some point in time of the installation, one of thewires 368 is “slid” into the buccal tube 384 and the other wire 368 isdisposed “under” the catch 388. Again, a ligature may further securethewire 368 which is disposed “under” the catch 388 to the band 380 viathe ligating tube 392. This interface between the cap 352 and the band380 via the wires 368 may be sufficient in and of itself. That is, thepolymerizing material within the cap 352 (which cures into a shape whichis in at least substantial conforming relation with the occlusal surfaceof the tooth) need not form a bond to the enamel of the tooth. In thiscase the mandibular advancer 52 ^(xiii) may then be configured as aremovable appliance for repeated removal and installation by thepractitioner or even the patient. In cases where the polymerizingmaterial does bond the cap 352 to the tooth, the wires 368 may shelteror protect the bond from at least certain destructive forces which couldotherwise cause this bond to fail. At a minimum the wires 368 functionto align the cap 362 onto the tooth.

Forces for affecting movement of the mandible 4 using the mandibularadvancer 52 ^(xiii) are realized by mounting the cap 352 in spacedrelation to the occlusal surface of the tooth on which the cap 352 ismounted. The spacing discussed above in relation to the crowns 280, 300,and 330 is equally applicable to the cap 352. In any case, the cap 352may assume a variety of configurations to provide an appropriate surfacefor affecting mandibular advancement forces. The configuration presentedin FIGS. 28-31 is sufficient. A transition section 354 exists betweenthe cap occlusal surface 356 and the cap skirt 360, which is of the samegeneral shape/configuration as the transition 342 of the crown 330 ofFIG. 25, and which is disposed on each of the mesial and distal ends ofthe cap 352. This transition section 354 may provide an appropriatesurface for interfacing with another mandibular advancer 52 on theopposing dental arch to affect a desired movement of the mandible 4 inthe same manner as the crown 330 of FIG. 25. The cap occlusal surface356 and/or the occlusal portion of the cap skirt 360 could also beconfigured into the shape utilized by the crown 102 of FIGS. 5-6, thecrown 176 of FIG. 16, the crown 252 of FIGS. 19-20B, the crown 280 ofFIGS. 21-22, and the crown 300 of FIGS. 23-24 to also affect mandibularmovement. It may also be possible to utilize the cap 352, alone but morelikely in combination with the band 380 and the above-describedinterconnecting wires 368, to provide enhanced occlusal support in amanner similar to the crown 330 discussed above in relation to FIG. 25.

The various mandibular advancers 52 described herein provide asignificant advance in one or more of the performance of the mandibularadvancement technique, as well as in the assembly of such advancers 52.Although certain of the mandibular advancers 52 were described above inrelation to a particular dental arch (i.e., the upper dental arch 26,the lower dental arch 6), each of the mandibular advancers 52 describedherein may be used on both the lower dental arch 6 and on the upperdental arch 26. Moreover, although certain of the mandibular advancers52 were positioned on the subject dental arch to affect mesialadvancement of the mandible 4, each of the mandibular advancers 52described herein may be installed on the lower arch 6 and/or the upperdental arch 26 to affect distal advancement of the mandible 4 (i.e., aretraction). Finally, any combination of the various mandibularadvancers 52 described herein may be used on the same side of the lowerdental arch 6 and the upper dental arch to affect advancement of themandible 4.

It should also be appreciated that the mandibular advancers 52 describedherein may benefit from the use of other appliances or armamentarium inconjunction therewith. For instance, it may be desirable to provide abuccal hook on each side of both the patient's upper dental arch 26 andlower dental arch 6 so that elastics may be utilized to facilitateengagement of the opposing mandibular advancers 52 (e.g., one elasticwhich interconnects the upper dental arch 26 and lower dental arch 6 onone side thereof, and another elastic which interconnects the upperdental arch 26 and lower dental arch 6 on the opposite side thereof). Incertain cases, these hooks may be directly attached to the buccal of themandibular advancer 52 itself (e.g., when formed from metal).

The foregoing description of the present invention has been presentedfor purposes of illustration and description. Furthermore, thedescription is not intended to limit the invention to the form disclosedherein. Consequently, variations and modifications commensurate with theabove teachings, and skill and knowledge of the relevant art, are withinthe scope of the present invention. The embodiments describedhereinabove are further intended to explain best modes known ofpracticing the invention and to enable others skilled in the art toutilize the invention in such, or other embodiments and with variousmodifications required by the particular application(s) or use(s) of thepresent invention. It is intended that the appended claims be construedto include alternative embodiments to the extent permitted by the priorart.

What is claimed:
 1. An mandibular advancement system which comprises: a casting form which comprises: 1) a casting form occlusal surface; 2) a casting form buccal surface which extends away from said casting form occlusal surface and toward a patient's gingiva when said system is installed on a first dental arch of said patient and which is associated with a buccal side of said first dental arch; 3) a casting form lingual surface which extends away from said casting form occlusal surface and toward said patient's gingiva when said system is installed on said first dental arch of said patient and which is associated with a lingual side of said first dental arch; and 4) a casting form mandibular advancement incline which is disposed on a first end of said casting form, which extends away from said casting form occlusal surface and toward said patient's gingiva, and which is disposed at an angle relative to an occlusal plane associated with said first dental arch when said system is installed on said first dental arch, wherein said casting form occlusal surface, said casting form buccal surface, and said casting form lingual surface define a hollow repository; and a first material which is disposed within said casting form and which has been polymerized into an at least substantially rigid structure within said casting form, wherein said casting form is mountable on said first dental arch with said first material projecting at least occlusally relative to said first dental arch so as to position said casting form mandibular advancement incline for at least facilitating mandibular advancement.
 2. A system, as claimed in claim 1, wherein: said casting form occlusal surface comprises first and second sections, wherein said first section extends from said first end toward a second end of said casting form, wherein said second section extends from said first section at least toward said second end of said casting form.
 3. A system, as claimed in claim 2, wherein: said first section is an at least substantially planar surface and is disposed at least substantially parallel with said occlusal plane when said system is installed on said first dental arch of said patient.
 4. A system, as claimed in claim 3, wherein: a length of said first section, as measured in a direction extending from said first end of said casting form to said second end of said casting form, is at least about the mesial-distal extent of a tooth in said first dental arch of said patient which underlies said first section when said system is installed on said first dental arch.
 5. A system, as claimed in claim 3, wherein: said second section extends from said first section, toward said second end and at least generally toward said patient's gingiva when said system is installed on said first dental arch of said patient.
 6. A system, as claimed in claim 1, wherein: at least a portion of said casting form occlusal surface is at least generally concave so as to account for a deep bite orthodontic condition of said patient when said system is installed on said first dental arch of said patient.
 7. A system, as claimed in claim 1, wherein: an occlusal-gingival extent of said casting form accounts for an open bite orthodontic condition of said patient when said system is installed on said first dental arch of said patient.
 8. A system, as claimed in claim 1, wherein: said casting form occlusal surface comprises a first section which extends from said casting form mandibular advancement incline back toward a second end of said casting form in at least substantially parallel relation with said occlusal plane and overlying an entirety of a tooth within said first dental arch when said system is installed on said first dental arch.
 9. A system, as claimed in claim 1, wherein: wherein an occlusal-gingival extent of said casting form buccal surface is different than an occlusal-gingival extent of said casting form lingual surface.
 10. A system, as claimed in claim 1, wherein: an occlusal-gingival extent of at least one of said casting form buccal and lingual surfaces varies in at least one location between said first end of said casting form and a second end of said casting form which is opposite said first end.
 11. A system, as claimed in claim 1, wherein: at least one of said casting form buccal and lingual surfaces comprises a cutout along a gingival-most edge of said casting form.
 12. A system, as claimed in claim 1, wherein: said first end further comprises an extension which projects from an edge of said casting form mandibular advancement incline toward said patient's gingiva when said system is installed on said first dental arch whereby said extension is thereby disposed between said patient's gingiva and said casting form mandibular advancement incline.
 13. A system, as claimed in claim 12, wherein: said first extension has an at least substantially u-shaped profile when looking at said first end of said casting form, towards a second end of said casting form opposite said first end.
 14. A system, as claimed in claim 12, wherein: said first extension is contoured to be disposed over and in at least generally mating relation across said first dental arch when said system is mounted on said first dental arch.
 15. A system, as claimed in claim 12, wherein: an occlusal-gingival extent of said first extension is greater than an occlusal-gingival extent of an adjacent portion of both said casting form buccal surface and said casting form lingual surface.
 16. A system, as claimed in claim 12, wherein: an occlusal-gingival extent of said extension is the same as an occlusal-gingival extent of an adjacent portion of at least one of said casting form buccal and lingual surfaces.
 17. A system, as claimed in claim 12, wherein: said extension is disposed between adjacent teeth in said first dental arch of said patient when said system is installed on said first dental arch.
 18. A system, as claimed in claim 1, wherein: a material which forms said casting form cross-links with said first material when disposed within said casting form.
 19. A system, as claimed in claim 1, wherein: said casting form mandibular advancement incline projects mesially when said system is installed on said first dental arch.
 20. A system, as claimed in claim 1, wherein: said casting form mandibular advancement incline projects distally when said system is installed on said first dental arch.
 21. A system, as claimed in claim 1, wherein: said first dental arch is selected from the group consisting of a mandible and maxilla of said patient.
 22. A system, as claimed in claim 1, further comprising: a crown which comprises a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface and toward said patient's gingiva when said crown is disposed over a tooth which is within said first dental arch of said patient; a crown mandibular advancement incline frame which is separately attached to said crown, wherein said crown mandibular advancement incline frame comprises first and second frame sections, wherein said second frame section extends away from said first frame section to define a first acute angle between said first and second frame sections, wherein said first frame section is attached to said crown occlusal surface so that said second frame section also at least generally extends away from said first dental arch of said patient when said crown is disposed over said tooth, wherein said crown with said crown mandibular advancement incline frame attached thereto are disposed within said casting form and are interconnected with said casting form by said first material, wherein said casting form mandibular advancement incline is disposed at least generally proximate to and at least generally parallel with said second frame section, wherein said second frame section comprises an at least substantially planar surface, and wherein said second frame section facilitates mandibular advancement.
 23. A system, as claimed in claim 22, wherein: said crown occlusal surface is planar.
 24. A system, as claimed in claim 22, wherein: said first frame section comprises at least one first aperture which extends down to said crown occlusal surface, wherein said first material occupies an entirety of said least one aperture and contacts a portion of said crown occlusal surface which is exposed by said at least one first aperture.
 25. A system, as claimed in claim 22, wherein: said first frame section comprises at least one second aperture which extends completely through said first frame section and which is disposed at an interproximal space between two teeth of said first dental arch when said system is installed on said first dental arch.
 26. A system, as claimed in claim 22, wherein: said first frame section further comprises a pair of extensions which each extend toward an end of said second frame section which is opposite that which interconnects with said first frame section, wherein said pair of extensions and said second frame section effectively collectively define a pocket, wherein said first material is disposed within and occupies an entirety of said pocket to support said second frame section against said first frame section and said crown occlusal surface.
 27. A system, as claimed in claim 1, further comprising: a crown which comprises a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface and toward said patient's gingiva when said crown is disposed over a tooth within said first dental arch of said patient, wherein said crown further comprises a crown mandibular advancement incline which is an at least a substantially planar surface and which is disposed at an angle relative to said occlusal plane when said crown is disposed over said tooth within said first dental arch, wherein said crown is disposed within said casting form and is interconnected with said casting form by said first material, wherein said casting form mandibular advancement incline is disposed at least generally proximate to and at least generally parallel with said crown mandibular advancement incline, and wherein said crown mandibular advancement incline facilitates mandibular advancement.
 28. A system, as claimed in claim 27, wherein: said crown mandibular advancement incline is integrally formed with said crown occlusal surface and said crown skirt whereby said crown mandibular advancement incline, said crown occlusal surface, and said crown skirt are formed from a single piece of material and with no joints therebetween.
 29. A system, as claimed in claim 27, wherein: said crown occlusal surface comprises a first crown occlusal surface which is disposed at a first elevation relative to said occlusal plane and a second crown occlusal surface which is disposed at a second elevation relative to said occlusal plane which is greater than said first elevation when said crown is disposed over said tooth, wherein said crown mandibular advancement incline is disposed between said first and second occlusal crown surfaces and is thereby part of said crown occlusal surface.
 30. A system, as claimed in claim 27, wherein: said crown mandibular advancement incline is disposed on only one of a mesial and a distal end of said crown at effectively an intersection between said crown occlusal surface and said crown skirt.
 31. A system, as claimed in claim 30, wherein: said crown occlusal surface at least generally approximates a contour of an occlusal surface of said tooth over which said crown is disposed when said system is installed on said first dental arch.
 32. A system, as claimed in claim 27, wherein: when said crown is disposed over said tooth of said first dental arch, there is at least about a 1.5 mm minimum space between an occlusal surface of said tooth and said crown occlusal surface.
 33. A system, as claimed in claim 32, further comprising: a polymerized material which occupies said space between said crown occlusal surface and said tooth when said crown is disposed over said tooth.
 34. A system, as claimed in claim 27, wherein: an extension projects away from said crown skirt in one of a mesial and a distal direction when said crown is disposed over said tooth, wherein said crown mandibular advancement incline is disposed on an end of said extension which is opposite said crown skirt.
 35. A system, as claimed in claim 27, wherein: said crown mandibular advancement incline defines an entirety of said crown occlusal surface, and is disposed at an angle of no more than about 20° relative two said occlusal plane.
 36. A system, as claimed in claim 1, further comprising: a band and a band mandibular advancement incline frame, wherein said band mandibular advancement incline frame comprises a band mandibular advancement incline which is an at least a substantially planar surface and which is disposed at an angle relative to said occlusal plane when said band is disposed about a tooth within said first dental arch, wherein said band is disposed within said casting form and is interconnected with said casting form by said first material, wherein said casting form mandibular advancement incline is disposed at least generally proximate to and at least generally parallel with said band mandibular advancement incline, and wherein said band mandibular advancement incline facilitates mandibular advancement.
 37. A method for installing a mandibular advancement system on a patient, comprising the steps of: disposing a first polymerizing material within a first casting form, wherein said first casting form comprises a first casting form mandibular advancement incline which is disposed on a first end of said casting form; executing a first positioning step comprising positioning said first casting form in at least overlying relation to at least part of at least two at least tooth-like structures associated with a first dental arch of a patient, wherein said first casting form mandibular advancement incline is disposed at an angle relative to a first occlusal plane associated with said first dental arch after said positioning step, and wherein said executing a first positioning step is executed after said disposing a first polymerizing material step; and curing said first polymerizing material to be at least substantially rigid, wherein said first casting form incline is disposed so as to facilitate mandibular advancement when said first casting form is installed on said first dental arch of said patient.
 38. A method, as claimed in claim 37, wherein: said first end of said first casting form comprises one of a distal end and a mesial end of said first casting form.
 39. A method, as claimed in claim 37, wherein: said executing a first positioning step comprises positioning said first casting form in at least overlying relation to least part of two teeth of a stone casting made of said first dental arch of said patient.
 40. A method, as claimed in claim 37, wherein: said executing a first positioning step comprises positioning said first casting form within a mouth of said patient and in at least overlying relation to least part of two teeth of said first dental arch of said patient, and wherein an entirety of said curing step is executed within said mouth of said patient.
 41. A method, as claimed in claim 37, wherein: said executing a first positioning step comprises interfacing said first polymerizing material with an occlusal surface of said at least two at least tooth-like structures, with at least a portion of a buccal surface of said at least two at least tooth-like structures, and with at least a portion of a lingual surface of said at least two at least tooth-like structures.
 42. A method, as claimed in claim 41, wherein: said executing a first positioning step further comprises interfacing said first polymerizing material with an interproximal spacing between two adjacent at least tooth-like structures associated with said first dental arch.
 43. A method, as claimed in claim 37, wherein: said executing a first positioning step comprises disposing said first end of said first casting form interproximally relative to two adjacent at least tooth-like structures associated with said first dental arch.
 44. A method, as claimed in claim 37, wherein: an entirety of said curing step is executed outside of a mouth of said patient.
 45. A method, as claimed in claim 37, wherein: an entirety of said curing step is executed within a mouth of said patient.
 46. A method, as claimed in claim 37, wherein: said executing a first positioning step comprises positioning said first casting form in at least overlying relation to least part of two teeth of a stone casting of said first dental arch of said patient, wherein said method further comprises the steps of: applying a release agent on at least part of said two teeth of said stone casting before said executing a first positioning step; and removing said first casting form from said stone casting after said disposing step and said executing a first positioning step, wherein at least a portion of said curing step is executed after said removing step.
 47. A method, as claimed in claim 46, wherein: said at least a portion of said curing step is executed within an oven.
 48. A method, as claimed in claim 46, further comprising the step(s) of: applying an adhesive to at least said first polymerizing material after said curing step; and mounting said first casting form with said first polymerizing material therein to at least part of an occlusal surface of at least two teeth within said first dental arch of said patient such that said first polymerizing material project toward said first dental arch.
 49. A method, as claimed in claim 37, further comprising the step(s) of: applying a release agent on at least part of a stone casting made of said first dental arch of said patient; executing a first disposing step comprising disposing a crown over a tooth of said stone casting; executing a second positioning step comprising positioning said first casting form in at least overlying relation to said crown and in at least overlying relation to least part of at least two teeth of said stone casting, wherein said disposing a first polymerizing material is executed before said executing a second positioning step and wherein said first polymerizing material directly interfaces with said crown; removing said crown and said first casting form from said stone casting after at least a portion of said curing step has been executed; applying an adhesive to at least said first polymerizing material after said curing step; and mounting said first casting form with said first polymerizing material and said crown therein on said first dental arch of said patient, wherein said mounting step comprises executing a second disposing step which comprises disposing said crown over a tooth within said first dental arch of said patient, wherein said mounting step further comprises said executing a first positioning step, and wherein said at least two at least two-like structures associated with said executing a first positioning step are actual teeth within said first dental arch of said patient.
 50. A method, as claimed in claim 49, wherein: said crown comprises a crown mandibular advancement incline, wherein said executing a second positioning step comprises positioning said crown mandibular advancement incline at least generally proximate to and at least in generally parallel relation with said first casting form mandibular advancement incline.
 51. A method, as claimed in claim 49, further comprising the step(s) of: placing a crown mandibular advancement incline frame on said crown after said executing a first disposing step and before said executing a second positioning step, wherein said crown comprises a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface, wherein said crown mandibular advancement incline frame comprises first and second frame sections, wherein said second frame section extends away from said first frame section to define a first acute angle between said first and second frame sections, wherein said placing step comprises placing said first frame section on said crown occlusal surface so that said second frame section at least generally extends away from both said crown occlusal surface and said crown skirt; marking a desired position of said crown mandibular advancement incline on said crown occlusal surface; removing said crown from said stone casting before said executing a second positioning step; replacing said crown mandibular advancement incline frame on said crown in said desired position using said marking step and after said removing said crown from said stone casting step; and attaching said crown mandibular advancement incline frame to said crown after said replacing step, wherein said executing a second positioning step is executed after said attaching step.
 52. A method, as claimed in claim 51, wherein: said executing a second positioning step comprises positioning said second frame section at least generally proximate to and at least in generally parallel relation with said casting form mandibular advancement incline.
 53. A method, as claimed in claim 51, wherein: said first frame section comprises at least one aperture, wherein said disposing a first polymerizing material step comprises directing said first polymerizing material within said at least one first aperture and to a portion of said crown occlusal surface which is exposed by said at least one first aperture.
 54. A method, as claimed in claim 51, wherein: said first frame section comprises at least one aperture, wherein said executing a first positioning step comprises directing said first polymerizing material within said at least one first aperture and to an interproximal location between two adjacent teeth of said stone casting.
 55. A method, as claimed in claim 51, wherein said executing a first positioning step comprises capturing the least a portion of said first polymerizing material to occupy an entirety of a space between said first and second frame sections so as to support said second frame section against said first frame section and said crown occlusal surface.
 56. A crown for affecting mandibular advancement which comprises: an integrally formed crown which is formed from a single piece of material and which is free from any joint, wherein said crown comprises a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface and toward a patient's gingiva when said crown is disposed over a tooth within a first dental arch of said patient, wherein said crown comprises a first crown mandibular advancement incline which is at least a substantially planar surface, which is disposed at an angle relative to an occlusal plane associated with said first dental arch, which is orientated to have a width dimension which is measured from a lingual surface associated with said first dental arch to a buccal surface associated with said first dental arch, and which facilitates mandibular advancement when said crown is disposed over said tooth.
 57. A crown, as claimed in claim 56, wherein: said crown occlusal surface comprises a first crown occlusal surface which is disposed at a first elevation relative to said occlusal plane and a second crown occlusal surface which is disposed at a second elevation relative to said occlusal plane and which is greater than said first elevation when said crown is disposed over said tooth, wherein said crown mandibular advancement incline is disposed between said first and second occlusal crown surfaces and is thereby part of said crown occlusal surface.
 58. A crown, as claimed in claim 56, wherein: said crown mandibular advancement incline is disposed on only one of a mesial and a distal end of said crown at an intersection between said crown occlusal surface and said crown skirt, and wherein said crown occlusal surface at least generally approximates a contour of an occlusal surface of said tooth over which said crown is disposed.
 59. A crown, as claimed in claim 56, further comprising: an extension which projects away from said crown skirt in only one of a mesial and a distal direction when said crown is disposed over said tooth, wherein said crown mandibular advancement incline is disposed on an end of said extension which is opposite said crown skirt.
 60. A crown, as claimed in claim 56, wherein: there is at least about a 1.5 mm space between said crown occlusal surface and an occlusal surface of said tooth over which said crown is disposed.
 61. A crown, as claimed in claim 60, further comprising: a polymerized material which occupies said space between said crown occlusal surface and said tooth when said crown is disposed over said tooth.
 62. A crown, as claimed in claim 56, wherein: said crown mandibular advancement incline defines at least substantially an entirety of said crown occlusal surface.
 63. A crown, as claimed in claim 56, wherein: said crown mandibular advancement incline is disposed at an angle of no more than about 20° relative to said occlusal plane.
 64. A crown, as claimed in claim 56, wherein: said crown mandibular advancement incline defines at least substantially an entirety of said crown occlusal surface; and said crown mandibular advancement incline is disposed at an angle of no more than about 20° relative to said occlusal plane.
 65. A crown, comprising: a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface and toward a patient's gingiva when said crown is disposed over a tooth of said patient, wherein said crown occlusal surface is planar.
 66. A crown, as claimed in claim 65, further comprising: a crown mandibular advancement incline frame which is attached to said crown, wherein said crown mandibular advancement incline frame comprises first and second frame sections, wherein said second frame section extends away from said first frame section to define a first acute angle between said first and second frame sections, wherein said first frame section is attached to said crown occlusal surface so that said second frame section also at least generally extends away from said crown occlusal surface.
 67. A crown, as claimed in claim 66, further comprising: a brazed joint between said crown occlusal surface and said first frame section.
 68. A crown, as claimed in claim 66, further comprising: at least one spot weld between said crown occlusal surface and said first frame section.
 69. A method for affecting advancement of a patient's mandible, comprising the steps of: installing one mandibular advancer on each upper first molar of said patient and on each lower first molar of said patient, wherein each said mandibular advancer comprises a crown and a mandibular advancement incline, wherein each mandibular advancement incline is a planar surface having an area of at least about 13 mm²; engaging said mandibular advancement incline on said upper first molars with a corresponding said mandibular advancement incline on said lower first molars; and using a camming action between said mandibular advancers on said lower first molars and said mandibular advancers on said upper first molars to advance said patient's mandible.
 70. A method, as claimed in claim 69, wherein: said installing step comprises disposing said mandibular advancement incline over at least substantially an entirety of an occlusal surface of the corresponding said first molar.
 71. A method, as claimed in claim 69, wherein: said installing step comprises disposing said mandibular advancement incline at an angle of no more than about 20° relative to an occlusal plane associated with a dental arch on which said crown is installed.
 72. A method, as claimed in claim 69, wherein: said installing step further comprises integrally forming said mandibular advancement incline with its corresponding said crown.
 73. A crown for affecting mandibular advancement which comprises: a crown occlusal surface and an annular crown skirt which extends away from said crown occlusal surface and toward a patient's gingiva when said crown is disposed over a tooth within a first dental arch of said patient, wherein said crown comprises a crown mandibular advancement incline which is at least a substantially planar surface, which is disposed at an angle relative to an occlusal plane associated with said first dental arch, which is orientated to have a width dimension which is measured from a lingual surface associated with said first dental arch to a buccal surface associated with said first dental arch, and which facilitates mandibular advancement when said crown is disposed over said tooth, wherein said crown mandibular advancement incline defines at least substantially an entirety of said crown occlusal surface.
 74. A crown, as claimed in claim 73, wherein: said crown mandibular advancement incline is disposed at an angle of no more than about 20° relative to said occlusal plane. 